APLICABILIDADE DA TOXINA BOTULÍNICA: ATUAÇÃO DO BIOMÉDICO

Treatment of hyperhidrosis

Introduction: Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. When administered orally in large quantities, it blocks nerve signals from the brain to the muscle, causing generalized paralysis, called botulism. However, by injecting very small amounts into a specific facial muscle, only the impulse that guides this muscle will be blocked, causing local relaxation. In this way, botulinum toxin acts as a blockade of the underlying muscles of the unwanted lines. In recent years, there has been an increase in the use of botulinum toxin in aesthetic procedures and knowledge about it is of great importance. Aim: The aim of this study was to demonstrate the use of botulinum toxin in aesthetic procedures. Methodology: This is a literature review study. Results: Botulinum toxin has been widely used in aesthetic procedures to temporarily reduce painful wrinkles, such as expression lines on the forehead, around the eyes (crow's feet) and between the eyebrows (glabella). Botulinum toxin is also used to treat gummy smiles, hyperhidrosis (excessive sweating) and facial asymmetry. Its aesthetic use provides a rejuvenated appearance and softens the marks of facial ageing. Clinical studies have shown positive results in terms of improved facial appearance and increased patient satisfaction with botulinum toxin procedures (CARRUTHERS, A., & CARRUTHER, J 2009). Conclusion: Botulinum toxin is extremely important in aesthetic procedures and requires a great deal of attention from professionals, as it brings great benefits if used correctly and in the correct dose.

Mycobacterium abscessus cutaneous infection secondary to botulinum toxin injection: A report of 2 cases

Botulinum toxin A (BT-A), a potential neurotoxin produced by the bacterium Clostridium botulinum, is known for its ability to prevent the release of acetylcholine at the neuromuscular synapse, leading to temporary muscle paralysis. BT-A is used for a wide range of therapeutic applications. Several studies have shown mechanisms beyond the inhibition of acetylcholine release for pain control. BT-A inhibits the release of neurotransmitters associated with pain and inflammation, such as glutamate, CGRP, and substance P. Additionally, it would be effective in nerve entrapment leading to neuronal hypersensitivity, which is known as a new pathogenesis of painful conditions. BT-A has been applied to the treatment of a wide variety of neurological disorders. Since 2010, BT-A application has been approved and widely used as a chronic migraine prophylaxis. Moreover, due to its effects on pain through sensory modulation, it may also be effective for other headaches. Several studies using BT-A, at different doses and administration sites for headaches, have shown beneficial effects on frequency and severity. In this review, we provide an overview of using BT-A to treat primary and secondary headache disorders.

ABSTRACTAim:This study aimed to compare the effectiveness, duration, and patient satisfaction of botulinum toxin A (BTX-A) and hyaluronic fillers in treating gummy smiles.Materials and Method:A prospective clinical study was conducted at D.Y. Patil University, involving 14 patients aged 18–40 years with a gummy smile of ≥3 mm. Participants were divided into two groups: Group A (BTX-A injections) and Group B (hyaluronic fillers). Gingival display was measured using standardized photographic methods at baseline and follow-up visits (14, 30, 60, and 90 days). Patient satisfaction was evaluated using the Global Aesthetic Improvement Scale (GAIS).Result:The results indicated that while BTX-A provided immediate improvements, hyaluronic fillers demonstrated more consistent and prolonged results. Patient satisfaction was higher in the hyaluronic filler group, with most patients reporting exceptional improvement (GAIS score of 1) across all follow-ups. No severe adverse effects were observed in either group.Conclusion:Hyaluronic fillers demonstrate superior effectiveness and patient satisfaction compared to BTX-A in the treatment of gummy smiles.

Botulinum toxin type A is a neurotoxin produced by the bacterium Clostridium botulinum which causes a flaccid muscle paralysis. It has been used extensively in the field of dermatology for the treatment of dynamic rhytides and in the treatment of hyperhidrosis. Botulinum toxin has an excellent safety profile and few side effects when used for these purposes. Recently, botulinum toxin has also been used experimentally in a number of other dermatologic conditions with good results. These conditions include: persistent facial flushing, gustatory sweating and epiphora, anal fissures, familial benign pemphigus (Hailey-Hailey disease), dyshidrotic eczema, and following surgical wound closures. While randomized, controlled prospective trials are still needed to further understand the efficacy and safety of botulinum toxin in these conditions, anecdotal and case report data suggest that botulinum toxin is both safe and efficacious in these and many other procedures.

A good management of aesthetic procedures available for the eye wrinkles area is fundamental for dermatologists. In addition to traditional aesthetic procedures such as superficial filler, peeling, and biorivitalization, in this chapter we will focus on two successful procedures: Botox and skin needling. A good knowledge of these procedures and their anatomic implication is necessary to provide the best treatment options for patients, manage complications appropriately, achieve optimal results, and avoid unwanted side effects. Glabellar frown lines as well as lateral canthal wrinkles in women can be satisfactorily treated with Botox. Botulinum toxin A is a natural substance, made by Clostridium botulinum bacteria, which cause a temporary paralysis of muscles. Skin needling is also called micro-needling therapy or collagen induction therapy. It is a minimally invasive nonsurgical and nonablative procedure for facial rejuvenation that involves the use of a micro-needling device to create controlled skin injury. For wrinkles of the periocular region, skin needling can be considered for the treatment of crow’s feet wrinkles and glabella wrinkles with good results. Professional skin needling is considered to be one of the safest skin treatment procedures. Unlike chemical peels, dermabrasion, and laser treatments, skin needling causes minimal damage to the skin.

Introduction: Keloids are the result of excessive scar tissue formation. Besides their poor aesthetic appearance, keloids can be associated with severe clinical symptoms such as pain, itching, and rigidity. Unfortunately, most therapeutic approaches remain clinically unsatisfactory. Recently, injections with botulinum toxin A (BTA) were proposed for the treatment of established keloids in a clinical trial. In this study, we aimed to verify the effects of intralesional BTA for the treatment of therapy-resistant keloids using objective measurements. In addition, the underlying molecular mechanisms were investigated using cultured keloid-derived fibroblasts. Materials and Methods: Four patients received BTA (doses varying from 70 to 140 Speywood units per session) injected directly into their keloids every 2 months for up to 6 months. Differences in height and volume were evaluated clinically and measured with a 3-D optical profiling system. Keloid-derived fibroblasts were treated with different concentrations of BTA, and expression of collagen (COL)1A1, COL1A2, COL3A1, TGF-β1, TGF-β2, TGF-β3, fibronectin-1, laminin-β2, and α-SMA was determined by real-time quantitative PCR. MTT and BrdU assays were used to analyze the effects of BTA on fibroblast proliferation and metabolism. Results: Intralesional administration of BTA did not result in regression of keloid tissue. No differences in expression of ECM markers, collagen synthesis, or TGF-β could be observed after BTA treatment of keloid fibroblasts. In addition, cell proliferation and metabolism of keloid fibroblasts was not affected by BTA treatment. Conclusion: The suggested clinical efficiency of intralesional BTA for the therapy of existent keloids could not be confirmed in this study. Based on our data, the potential mechanisms of action of BTA on keloid-derived fibroblasts remain unclear.

M614: The Art and Science of Botulinum Toxins in Oral Surgical Practice

The International Society of Aesthetic Plastic Surgery estimates that 18,857,311 non-invasive aesthetic procedures were carried out worldwide in 2022. This represents an increase of 7.2% compared to 2021 and 57.8% compared to 2018. Brazil is the second country in the world, just behind the United States, in the number of aesthetic procedures, with 3,020,552. Of these, 971,294 were non-invasive, with the administration of botulinum toxin, at 433,263, being the most frequent procedure. In aesthetics, it is used for the treatment of facial asymmetries, expression lines, hyperhidrosis in the hands, feet, armpits, face, and inguinal region, and in the treatment of gummy smile, attenuation of forehead wrinkles, perioral wrinkles, mental creases, glabellar lines, periorbital wrinkles, nasal wrinkles, wrinkles found on the décolletage, nasal tip stabilization, drooping lips, eyebrow lifting, and platysma bands. The most common adverse reactions associated with the use of botulinum toxin are burning, pain, swelling, irritation at the application sites, hypersensitivity, anaphylaxis in extreme cases, blurred vision, dry mouth, rarely respiratory failure, and muscle weakness. The objective of the study was to describe the adverse events (AEs) reported in the Vigimed system between 2019 and 2022. In the period analyzed, only 50 possible AEs were reported, with the female gender and the age group of 18 to 44 years being the most frequent. The pharmaceutical industry was responsible for 82% of the notifications analyzed, however, when evaluating the reporting professional, it was observed that pharmacists reported in only 8% of the cases. When evaluating the most reported AEs, swelling and pain were the most frequent, at 30% and 24% respectively. The underreporting of these events and the need for public and private incentives to raise awareness among health professionals and users about the need for identification and reporting of AEs is clear.

Currently, concern about facial attractiveness is increasing, and this fact has led to orthodontics in adult patients being an increasingly demanded treatment, and with it, multi-disciplinary work. When it is caused by a vertical excess of the maxilla, the ideal solution is orthognathic surgery. However, in borderline cases and when the cause is hyperactivity of the upper lip levator muscle complex, alternative conservative solutions can be considered, such as the application of botulinum toxin A (BTX-A). Botulinum toxin is a protein produced by a bacterium and causes a reduction in the force of muscle contraction. The multi-factorial nature of the smile requires an individualized diagnosis in each patient, since there are multiple ways to treat the gummy smile (orthognathic surgery, gingivoplasty, orthodontic intrusion). In recent years, interest has grown in the simplest techniques that allow the patient to quickly return to their usual routine, such as lip replacement. However, this procedure shows recurrences in the first 6–8 post-operative weeks. The main objective of this systematic review and meta-analysis is to analyze the effectiveness of BTX-A in the treatment of gummy smile in the short term, to study its stability, and to evaluate potential complications. A thorough search of the PubMed, Scopus, Embase, Web of Science, and Cochrane databases and a grey literature search were conducted. The inclusion criteria were studies with a sample size greater than or equal to 10 patients with gingival exposure greater than 2 mm in smile, treated with BTX-A infiltration. Those patients whose exclusive etiology of their gummy smile was related to altered passive eruption, gingival thickening, or overeruption of upper incisors were excluded. In the qualitative analysis, the mean pre-treatment gingival exposure ranged between 3.5 and 7.2 mm, reaching a reduction of up to 6 mm after infiltration with botulinum toxin at 12 weeks. Although multiple muscles are involved in the facial expression, the muscles par excellence selected for blockade with BTX-A were levator labii superioris, levator labii superioris ala nasalis, and zygomaticus minor, infiltrating from 1.25 to 7.5 units per side. In the quantitative analysis, the difference in mean reduction between both groups was −2.51 mm at two weeks and −2.24 mm at three months. The benefit of BTX-A in terms of improvement of gummy smile is demonstrated, as a significant reduction in gummy smile is estimated by BTX-A therapy two weeks after its application. Its results gradually decrease over time, however, they stay satisfactory without returning to their initial values after 12 weeks.

Excessive gingival exposure (gummy smile) is a non-aesthetic condition characterized by excessive exposure of the gingiva during smiling. The most common cause of gummy smiles was reported to be the hyperfunction of the muscles of the upper lip. Previous reports showed that botulinum toxin (Botox) is effective in the treatment of gummy smiles with a reversible effect, rapid initial action, safe application, low risk, and satisfactory outcome. The effect of Botox is usually observed between one and two weeks. This study aims to review the recent updates and guidelines for gummy smile treatment using botulinum toxin. A literature review was conducted involving relevant studies discussing gummy smile treatment using botulinum toxin with no time restriction. The PubMed and Google Scholar databases were used to gather the most relevant studies. The initial screening revealed 62 studies, and after removing the out-of-scope studies, the final review included 28 studies. Botulinum toxin can be used effectively for the treatment of gummy smile caused by lip dynamics with rarely reported complications. However, the most observed limitation was the temporary duration, which was reported to range from four to six months, and the re-injection of botulinum toxin is usually needed.

Introduction and purpose: Sweating plays an important role in the mechanism of human thermoregulation. A state in which the amount of sweat produced exceeds the physiological demand is called hyperhidrosis. About 4.8% of the population complains of this condition. The inconvenience of excessive sweat production significantly decrease the standard of living of patients suffering from this disorder. Nowadays, botulinum toxin injections are increasingly being used as a therapy for excessive sweating. Brief description of the state of knowledge: Botulinum toxin is an exotoxin produced by the bacteria Clostridium botulinum . It is now considered one of the most potent poisons found in nature. Thanks to research conducted since the 1970s, the positive effects of using TB to treat strabismus, eyelid spasm, torticollis and other conditions associated with excessive muscle spasticity have been noted. This discovery coused a flood of subsequent research on the use of botulinum toxin in medicine and cosmetology. It derives its features from inhibiting the release of Acetylcholine in nerve endings, which prevents muscle contraction. Acetylcholine is the main transmitter of the sympathetic nervous system, which innervates the sweat glands. Thanks to these features, botulinum toxin has begun to be widely used to treat excessive sweating. Summary: Excessive sweating is very often resistant to treatment attempts with iontophoresis or external substances. Botulinum toxin injections into the areas most affected by the condition, which are most often the hands, feet, armpits, bring significant improvement in patients. Currently, research is being conducted about the use of botulinum toxin in other areas of the body.

BackgroundHyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required.AimWe designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis.Materials and methodsTwenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied).ResultsBoth treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups.ConclusionLidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.

Botulinum toxin A(BoNT/A) is a neurotoxin produced by the bacteria Clostridium botulinum, which can cause serious food poisoning and is recognized as a potential biological warfare agent. BoNT/A is does not degrade easily and can remain in the complex matrix for a long time. Meanwhile, the poisonous dose of botulinum toxin exceptionally low and intravenous human lethal doses estimated at 1-3 ng/kg. Therefore, sensitive and accurate detection methods suitable for testing a wide range of complex samples are urgently needed. To this end, the “amplified luminescent proximity homogeneous assay linked immunosorbent assay” (AlphaLISA) was established for the detection of BoNT/A and its detection efficacy in plasma, beverage, food, and other complex samples was evaluated. The results showed that this method can very effectively resist matrix interference. The detection time is rapid, reaching a detection limit for all samples of up to 0.1 ng/mL in only 30 min. BoNT/A can also be accurately detected in vomit samples of patients with clinical food poisoning. This study demonstrates that AlphaLISA is an effective tool for the detection of BoNT/A in complex samples and can potentially be developed for commercial use in the future.