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J Skin Stem Cell. 2024 June; 11(2): e145639. https://doi.org/10.5812/jssc-145639.
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Facial Acne Management and Sebum Reduction via Botulinum To
x
in
T
y
pe A Treatment: A Review
Serap Maden 1 , *
1 Department of Dermatolog
y
, Facult
y
of Medicine, Near East Universit
y
, Nicosia, C
y
prus
*
Corresponding author:
Department of Dermatolog
y
, Facult
y
of Medicine, Near East Universit
y
, Nicosia, C
y
prus. Email: serap.maden@neu.edu.tr
Received
2024 Februar
y
3;
Revised
2024 Februar
y
21;
Accepted
2024 March 3.
Abstract
Context:
Acne is a common skin condition characterized b
y
chronic inflammation of the pilosebaceous unit. Increased sebum
production is a ke
y
component of acne pathogenesis. Various therapies are available for acne, including topical, s
y
stemic, and
ph
y
sical treatments. Botulinum to
x
in is increasingl
y
used in facial cosmetic procedures. Observations suggest that botulinum
to
x
in t
y
pe A (BoNT-A) ma
y
reduce sebum levels in the face. This finding could potentiall
y
lead to the development of a new
treatment for oil
y
skin and acne.
Evidence Acquisition:
A retrospective literature review was conducted b
y
searching the PubMed, Web of Science, EMBASE, and
SCOPUS databases using ke
y
words such as "acne," "acne treatment," "oil
y
skin," and "botulinum to
x
in t
y
pe A." The review focused
on studies that assessed the impact of BoNT-A on patients with acne vulgaris and oil
y
skin, as well as studies that measured skin
sebum levels and pore size following BoNT-A application.
Results:
Nine studies were reviewed. Of these, two evaluated the effects of BoNT-A on 30 and 35 patients with acne vulgaris. Four
studies assessed sebum reduction in 20, 50, 42, and 20 patients. Three studies evaluated both sebum reduction and pore size
tightening in 10, 25, and 20 patients. Eight studies demonstrated that the application of BoNT-A has a positive effect on patients
with acne and reduces sebum production in facial skin. Onl
y
one stud
y
, which evaluated both sebum reduction and pore size
tightening, found no significant effect. Overall, the studies indicate that BoNT-A application can positivel
y
impact acne and
reduce facial sebum production. Specificall
y
, intradermal application of BoNT-A at low dosages can help reduce acne, sebum
production, and tighten pores.
Conclusions:
BoNT-A shows promise as a treatment for acne and oil
y
skin. While cost-effectiveness ma
y
be a challenge for some
patients, the benefits of BoNT-A make it a treatment option worth considering. With further studies to optimize dosages and
determine the longest duration of efficac
y
, BoNT-A has the potential to revolutionize the treatment of acne and oil
y
skin.
Keywords:
Acne, Botulinum To
x
in T
y
pe A, Treatment
1. Context
1.1. Acne and Sebum Production
Acne is a prevalent inflammator
y
skin condition
characterized b
y
chronic inflammation of the
pilosebaceous unit (1). The pathogenesis of acne involves
multifaceted processes, including increased sebum
production, follicular keratinization, colonization of
Cutibacterium acnes
, hormonal influences, skin
microbiome alterations, and chronic inflammation (2).
Acne t
y
picall
y
appears on bod
y
parts with sebaceous
glands, such as the face, neck, chest, upper back, and
upper arms. Sebum secretion causes these areas to
appear oil
y
and shin
y
(3). Acne lesions begin as
microcomedones, which can progress into non-
inflammator
y
closed and open comedones, and then
into inflammator
y
lesions like papules, pustules, and
nodules (4). The chronic course of acne imposes
ps
y
chological and economic burdens on patients,
significantl
y
impairing their qualit
y
of life (5).
Seboc
y
tes located in sebaceous glands release sebum
through holocrine secretion. Sebum is composed of
squalene, wa
x
esters, trigl
y
cerides, free fatt
y
acids,
cholesterol esters, and free sterols (6). It helps deliver
lipid-soluble antio
x
idants to the skin's surface and has
Maden S
2 J Skin Stem Cell. 2024; 11(2): e145639.
antimicrobial activit
y
, making it the bod
y
's most critical
barrier against e
x
ternal influences (7). Increased sebum
production contributes to the development of acne (2).
It also causes enlarged facial pores, which can be a
cosmetic concern for patients without acne (8).
Although sebaceous glands were previousl
y
thought
to be controlled solel
y
b
y
humoral mechanisms, clinical
observations have suggested that the
y
are also affected
b
y
neurological factors. A potential link between
neuronal control and sebum secretion was suggested b
y
the finding that paraplegic patients had more sebum on
their thighs compared to non-paraplegic controls.
Additionall
y
, clinicians have observed changes in sebum
secretion and increased acne occurrence in cases of
partial facial paral
y
sis. Furthermore, topical
anticholinergics have been shown to be effective in the
reduction of sebum secretion (9). In this conte
x
t, several
studies have also demonstrated the presence of
acet
y
lcholine (Ach) receptors on sebaceous glands (10,
11).
1.2. Botulinum Toxin Type A
Clostridium botulinum
is a gram-positive, anaerobic,
spore-forming bacterium that produces neuroto
x
ins
known as botulinum neuroto
x
ins (BoNT). Serot
y
pes of
BoNTs range from botulinum to
x
in t
y
pe A (BoNT-A) to
botulinum to
x
in t
y
pe H. BoNT-A has the abilit
y
to inhibit
cholinergic neuromuscular innervation in both striated
and smooth muscles, as well as cholinergic autonomic
innervation in e
x
ocrine glands, depending on the
specific target tissue (12). In the 1970s, it was discovered
that BoNT-A had therapeutic potential, making it the
most widel
y
used BoNT in clinical applications (13).
Additionall
y
, BoNT-A was approved b
y
the FDA in 1989 for
the treatment of blepharospasm and strabismus.
Further research has led to the development of new
formulations and e
x
panded the range of indications
(14). In 2002, the FDA approved the use of BoNT-A for
cosmetic purposes (15). As a result, BoNT-A has become
widel
y
used b
y
neurologists and cosmetic practitioners
(14).
The mechanism of action of BoNT involves inhibiting
the release of acet
y
lcholine (Ach) from motor terminals,
which results in the inabilit
y
of skeletal muscles to
contract despite continued action potential
transmission to the motor end plate. BoNT achieves this
b
y
inactivating the SNARE proteins, which are crucial for
the release of Ach. The chemical paral
y
sis of the muscles
resulting from this process is reversible, with the
duration of paral
y
sis depending on the light chain half-
life and SNARE protein turnover time (14).
BoNT-A is a viable option for temporaril
y
improving
moderate to severe glabellar or frown lines (15).
Observations following BoNT-A application showed a
significant decrease in pore size and number, as well as a
reduction in skin oiliness in most patients (16).
Moreover, it was observed that patients who received
BoNT-A treatment for facial wrinkles e
x
perienced a
significant reduction in acne, indicating a therapeutic
effect on acne (17). In addition to conventional
treatment methods, an increasing number of published
clinical reports support the use of BoNT-A in treating
acne and oil
y
skin (18-26) (Table 1).
2. Evidence Acquisition
We conducted a literature search on the PubMed,
Web of Science, EMBASE, and SCOPUS databases using
ke
y
words such as 'acne,' 'acne treatment,' 'oil
y
skin,' and
'botulinum to
x
in t
y
pe A.' We reviewed studies that
assessed the impact of BoNT-A on patients with acne and
oil
y
skin, as well as studies that measured skin sebum
levels and pore size following BoNT-A application.
3. Results
3.1. Treatment Methods of Acne
3.1.1. Topical Treatment of Acne
Topical regimens for acne patients t
y
picall
y
include
combinations such as er
y
throm
y
cin or clindam
y
cin
with benzo
y
l pero
x
ide, as well as treatments like topical
retinoids, dapsone gel, azelaic acid, adapalene, and
tretinoin (27).
3.1.2. Systemic Treatment of Acne
S
y
stemic antibiotic options for acne management
include oral do
xy
c
y
cline, minoc
y
cline, er
y
throm
y
cin,
azithrom
y
cin, and trimethoprim/sulfametho
x
azole or
trimethoprim. Hormonal treatments such as
spironolactone and combined oral contraceptives are
also utilized. Oral isotretinoin is indicated for severe
nodular acne and is also suitable for moderate acne that
has not responded to other therapies or for acne that
causes scarring or significant distress to the patient.
Women of reproductive age should receive information
about contraception prior to initiating isotretinoin
treatment. It is recommended to perform baseline liver
function tests, as well as serum cholesterol and
trigl
y
ceride measurements initiall
y
, and to repeat these
tests during the course of treatment (27).
Maden S
J Skin Stem Cell. 2024; 11(2): e145639. 3
Table 1.
Botulinum To
x
in for the Management of Acne and Sebum Reduction
Authors and
Year Type of Study Object Technique of
Injection Methods Follow-up Results
Ibrahim et
al,2023 (
18
)
Prospective,
randomized,
split face
Acne
improvement Intralesional
Thirt
y
patients with inflammator
y
acne received intralesional BoNT-A
(Neurono
x
) on one side and long-
pulsed Nd: YAG 1064 nm laser on the
other side. The treatment was
applied monthl
y
until improvement
or a ma
x
imum of three sessions.
The Investigator's
Global Assessment of
acne (IGAs) was utilized
to evaluate acne lesions
at baseline, each
session, and after a 3-
month follow-up.
There was a statisticall
y
significant
improvement in the count of lesions
and IGAs for both sides of the face.
There was no statisticall
y
significant
difference between both sides at the
end of the treatment sessions. Facial
weakness is seen in one patient.
Calvisi et al,
2021(
19
)
Prospective,
uncontrolled Acne
improvement Intradermal
Thirt
y
-five patients with mild to
moderate acne were treated with
BoNT-A (Vistabe
x
) injections. The
injections were administered
intradermall
y
on the cheek in a
regular grid pattern using tin
y
droplets (~0.01 mL, 0.2 U/cm2).
The methods of
measurement used
were photograph
y
,
patient assessment, and
Michaelsson acne
scores (MAS).
Thirt
y
-three patients, showed a
significant improvement in the MAS
score after treatment. A reduction in
the number of papules and pustules
was observed 14 da
y
s after treatment,
with a significant decrease in their
mean number at the end of 4 weeks.
Two patients that did not respond
well to the treatment. No adverse
effects were observed.
Shirshakova
et al,
2021(
20
)
Prospective,
uncontrolled Sebum
reduction Intradermal
Twelve patients with acne were
injected intradermall
y
with 6 - 8 U
BoNT-A (no brand name) per
injection area at a concentration of
0.25U/cm2on the face.
Sebum secretion was
measured using a
sebumeter.
There was a statisticall
y
significant
reduction in skin oiliness, with the
greatest effects observed two weeks
after treatment. No significant side
effects were reported.
Kesty and
Goldberg,
2021(
21
)
Double blind,
randomized,
controlled
Sebum
reduction Intradermal Fift
y
health
y
volunteers received
injections of 0, 15, 30, or 45 units of
BoNT-A (D
y
sport) in their forehead.
Sebumeter readings,
patient assessments,
and investigator scores
were utilized.
Patients who received either 30 or 45
U reported a significant reduction in
oil
y
skin, which persisted for 6
months. No significant side effects
were observed.
Sapra et al,
2017(
22
)
Single blind,
randomized,
controlled
Sebum
reduction, pore
size tightening Intradermal
Ten women between the ages of 35
and 65 with static wrinkles received
intradermal injections of BoNT-A
(Boto
x
and D
y
sport) in week 0,
followed b
y
intramuscular
injections in week 2. The volume of
BoNT-A used for treatment was
based on individual needs and
applied in a regular 1 cm2 grid across
the forehead and cheeks.
Sebutape, gra
y
-scale 3D
Vectra, and
photographic evidence
were utilized.
There was no significant effect on
sebum production or pore size
following intradermal BoNT-A
injection.
Min et al,
2015 (
23
)
Double blind,
randomized,
controlled
Sebum
reduction Intramuscular
Fort
y
-two female patients with
forehead rh
y
tids received
intramuscular injections of BoNT-A
(Boto
x
) at doses of 2 or 4 units per
point in five standard injection sites
on the forehead. The control group
was injected with saline.
Sebum secretion was
measured using a
Sebumeter at follow-up
appointments at 2, 4, 8,
and 16 weeks.
There was a statisticall
y
significant
reduction in the amount of sebum
secreted at the injection site. There
was no statisticall
y
significant
difference between the 2 U and 4 U
regimens. The reduction in sebum
production is most significant
around 2 - 4 weeks after treatment,
and levels return to normal at 16
weeks.
Rose and
Goldberg,
2013 (
24
)
Prospective,
uncontrolled
Sebum
reduction, pore
size tightening Intradermal
Twent
y
-five patients between the
ages of 35 and 50, consisting of 5
men and 20 women with oil
y
skin,
were intradermall
y
injected with
BoNT-A (D
y
sport) at a dose of 3 - 5 U
per point in 10 points on the
forehead.
Measurements were
taken during follow-up
using a sebometer,
photograph and
patient assessments
were also recorded.
There was a statisticall
y
significant
reduction in sebum at follow-up. At 1
week, the effect was greatest, and
there was still a statisticall
y
significant reduction at 3 months. No
significant side effects were observed
e
x
cept for a decrease in frontalis
muscle tone in two patients.
Li et al, 2013
(
25
)
Double blind,
randomized,
controlled
Sebum
reduction Intradermal
The stud
y
involved 20 patients aged
21 - 37
y
, 10 with oil
y
skin and 10 with
dr
y
skin. One side of the face was
injected with BoNT-A (Medito
x
in)
(2U/0.1 mL/cm2), while the other side
was injected with a placebo (normal
saline).
Sebum secretion was
measured using a
sebumeter and digital
image anal
y
sis.
The group with oil
y
skin showed a
statisticall
y
significant reduction in
sebum secretion, while no change
was observed in the group with dr
y
skin. The effect was most prevalent 4
weeks after treatment, and no
significant side effects were reported.
Shah 2008
(
26
)
Retrospective,
uncontrolled
Sebum
reduction, pore
size tightening
İ
ntradermal
Twent
y
patients received
intradermal injections of BoNT-A
(Boto
x
) in the T-zone, with a dosage
of 0.1 mL (0.2 U/0.1 mL).
Measurements were
taken during follow-up
using photograph and
patient assessments.
85% of patients e
x
pressed satisfaction
with the improvement in oiliness and
pore size, and no visible
complications were observed.
3.1.3. Physical Treatment Methods of Acne
Ph
y
sical treatments, such as chemical peels (e.g.,
salic
y
lic acid, mandelic acid, Jessner’s peel) and light
therapies (including photochemical therapies such as
blue, red, or combined blue/red light, and
photod
y
namic therap
y
, which involves a light source
such as red light, blue light, or da
y
light, along with a
photosensitizing chemical such as 5-aminolaevulinic
Maden S
4 J Skin Stem Cell. 2024; 11(2): e145639.
acid or meth
y
l aminolaevulinate), are other modalities
used for acne treatment (28).
3.2. Acne, Sebum Production and Botulinum Toxin Type A
The use of BoNT-A has e
x
panded to various areas in
dermatolog
y
. While it is commonl
y
used for cosmetic
purposes, it has also been shown to improve enlarged
pores, scars, and oil
y
skin (29). In a recent stud
y
, BoNT-A
was used to treat patients with inflammator
y
acne. This
prospective randomized split-face comparative stud
y
aimed to compare the clinical efficac
y
and safet
y
of
long-pulsed Nd:YAG laser 1064 nm with intralesional
BoNT-A for managing inflammator
y
acne. Thirt
y
patients with inflammator
y
acne were treated with the
long-pulsed neod
y
mium: Yttrium-aluminum-garnet
(Nd:YAG) laser 1064 nm on one side of their faces and
intralesional BoNT-A on the other side, monthl
y
, for a
ma
x
imum of three sessions, until improvement was
observed. Acne cases were evaluated b
y
counting lesions
and grading severit
y
using the Investigator's Global
Assessment of Acne (IGA) at baseline, each session, and
after a 3-month follow-up. A dose of 2.5 units (U) of
BoNT-A (Neurono
x
®, Med
y
to
x
Inc., Gangnam-gu, Seoul,
South Korea) was injected per 0.1 ml intradermall
y
directl
y
into acne lesions, with 1 to 3 U of BoNT-A per
lesion. The ma
x
imum dose used per session was 20 U,
and the distance between adjacent injection points was
2 to 3 cm. A statisticall
y
significant improvement in the
number of lesions and IGA scores was recorded for both
sides, with a statisticall
y
non-significant difference
between the two sides at the end of the treatment
period. After a 3-month follow-up, a more significant
improvement was observed on the laser therap
y
side. In
conclusion, both long-pulsed Nd:YAG laser 1064 nm and
intralesional BoNT-A were found to be safe and effective
for acne therap
y
. However, it should be noted that
intralesional BoNT-A was found to be less effective and
had a higher recurrence rate than Nd:YAG laser 1064 nm.
A side effect was observed in one patient after the
second session, manifesting as weakness in the facial
muscles (18). Another stud
y
aimed to treat patients with
acne and rosacea using BoNT-A. A total of 35 patients
with mild to moderate acne were treated with
intradermal injections of BoNT-A (Vistabe
x
®, Allergan
S.p.a., Via Salvatore Quasimodo, 134 - 138, 00144 Roma) on
the cheek in a regular grid pattern using ver
y
small
droplets (~0.01 mL, 0.2 U/cm²). After treatment, 33
patients e
x
hibited a significant (> 55.4%) improvement
in the Michaelsson acne scores and a 3.6 rating in the
Subject Global Aesthetic Improvement Scale, while two
did not respond effectivel
y
to treatment. A reduction in
the number of papules and pustules was observed 14
da
y
s after treatment, with a significant decrease in the
mean number of papules and pustules at the end of 4
weeks. No adverse effects were reported in the stud
y
(19).
In one stud
y
assessing changes in facial skin seborrhea
and enlarged pores, a multifocal intradermal technique
was used evenl
y
over the entire facial area of 12 patients
at a dosage of 0.25 U/cm² or 0.125 U/0.5 cm² of an
unidentified brand of BoNT-A formulation. The stud
y
reported a significant reduction (P ≤ 0.01) in sebum
secretion and pore diameter with BoNT-A treatment
compared to baseline levels. No side effects were
observed in the stud
y
(20). A double-blind, randomized,
placebo-controlled stud
y
was conducted to assess the
efficac
y
of BoNT-A injections for treating oil
y
skin on the
forehead. The stud
y
involved 50 male and female
subjects who received intradermal injections of a
randomized number of units of BoNT-A (D
y
sport®,
Galderma Laboratories, L.P., Fort Worth, TX) in their
forehead. The doses of BoNT-A administered were 0, 15,
30, or 45 U. Both researchers and subjects reported a
significant decrease in forehead oiliness after receiving
at least 30 U of BoNT-A (P < 0.05). Additionall
y
, subjects
who received 30 or 45 U of BoNT-A had significantl
y
lower sebometer counts compared to both the placebo
group and subjects treated with 15 U of BoNT-A (P <
0.05). This effect persisted at the 6-month follow-up
visit. No adverse events related to treatment were
observed during the stud
y
(21). Another stud
y
, a single-
blind, split-face, randomized pilot stud
y
, involved ten
women aged between 35 and 65 with static wrinkles in
the glabellar and periorbital areas. The stud
y
aimed to
evaluate the difference in the effect of intradermal and
intramuscular application of two commercial BoNT-A
products for treatment. The products were
administered based on individual requirements and
applied in a consistent 1 cm² pattern across the forehead
and cheeks during week 0, followed b
y
intramuscular
injections in week 2. However, intradermal injection of
BoNT-A did not result in a significant reduction in pore
size or sebum production among patients (22). A
prospective randomized double-blind stud
y
was
conducted on 42 female patients with forehead
wrinkles. The
y
were injected with BoNT-A (Boto
x
®,
Allergan, Irvine, CA) intramuscularl
y
. The stud
y
compared the effects of administering 2 U versus 4 U of
BoNT-A in the forehead region. A total of 10 to 20 U of
BoNT-A was administered intramuscularl
y
as a
treatment. The administration of BoNT-A through
intramuscular injection significantl
y
reduced sebum
production compared to baseline measurements. This
effect was not dependent on the dosage of the
Maden S
J Skin Stem Cell. 2024; 11(2): e145639. 5
treatment. After 16 weeks, sebum production levels
returned to their original levels (23). Another stud
y
evaluated the efficac
y
and safet
y
of BoNT-A for oil
y
skin
in 5 male and 20 female subjects with mild to moderate
forehead oiliness. A total of 30 - 45 U of BoNT-A
(D
y
sport®, Medicis, Scottsdale, AZ) were injected
intradermall
y
into the frontalis muscle region at 10
points, with 3 - 5 U at each point. Sebum production
significantl
y
decreased at all follow-up time points
assessed (P < 0.001), as measured b
y
the sebometer. The
patients' satisfaction rate was 91% based on their
evaluations. Two subjects e
x
hibited a decrease in
frontalis muscle tone two months after treatment. No
additional side effects were observed in the stud
y
(24). Li
et al. conducted a double-blind, placebo-controlled,
split-face stud
y
involving twent
y
health
y
volunteers
aged 21 - 37
y
ears. One side of each participant's face was
injected intradermall
y
with 2 U/cm² of BoNT-A
(Medito
x
in®, Med
y
to
x
, Seoul, Korea) at four points,
while the control side received normal saline injections.
Among the participants, ten were categorized as having
oil
y
skin, while the remaining had dr
y
to normal skin.
After the intradermal injection of BoNT-A, the oil
y
skin
group e
x
hibited a statisticall
y
significant reduction in
pore size and a marked decrease in sebum production
after 4 weeks. No significant adverse effects were
detected throughout the stud
y
(25). A retrospective
stud
y
assessed the safet
y
and effectiveness of a single
intradermal injection of BoNT-A in reducing pore size
and sebum e
x
cretion on the forehead, nose, and chin in
20 patients. One month after the injection, 17 out of 20
patients reported a decrease in pore size and sebum
production. The patients e
x
pressed satisfaction with the
procedure and did not e
x
perience an
y
complications
(26).
3.3. Physiologic Effects of Botulinum Toxin Type A on Acne
and Sebum Production
Non-neuronal cells throughout the bod
y
e
x
press a
major subunit of nicotinic acet
y
lcholine receptors
(nAchR), known as nAchRa7 (30). The sebaceous gland
prominentl
y
e
x
presses distinct nAchR subunits,
including nAchRa7, and releases acet
y
lcholine (Ach)
through autocrine mechanisms (10, 11). The inhibitor
y
effect of
α
-bungaroto
x
in on Ach-induced lipid s
y
nthesis
supports the conclusion that nAchRa7 e
x
pression in
human seboc
y
tes pla
y
s a role in this process. Therefore,
it has been demonstrated that Ach signaling increases
sebum production (25). Moreover, in vitro findings have
shown that oil
y
skin ma
y
be more susceptible to
cholinergic modulation compared to normal skin due
to the higher number of mature seboc
y
tes with
increased cholinergic receptors (25).
Contraction of the arrector pili muscles can
significantl
y
affect sebum e
x
cretion (31). Li et al.
demonstrated that cholinergic signaling impacts
seboc
y
tes and sebum production and that BoNT-A
reduces sebum production (25). Additionall
y
, it is
predicted that BoNT-A activit
y
affects the arrector pili
muscle, which in turn influences sebum production and
pore size (24).
In the treatment of inflammator
y
acne, BoNT-A is
proposed to block Ach at the s
y
naptic cleft, thereb
y
inhibiting cholinergic innervation of the sebaceous
gland and ultimatel
y
reducing sebum production (25).
In addition, local muscarinic receptors and arrector pili
muscles are inhibited (24), resulting in reduced sebum
production and minimized pore size. Furthermore,
BoNT-A suppresses neurogenic inflammation b
y
inhibiting substance P, tumor necrosis factor-
α
,
calcitonin gene-related peptide, and neurokinin (20, 32).
Therefore, BoNT-A has the potential to benefit acne b
y
reducing inflammation, a ke
y
component of acne
pathogenesis.
The studies indicate that BoNT-A can effectivel
y
reduce sebum secretion and skin oiliness when
administered in appropriate dosages. Two studies on
acne treatment showed that BoNT-A was effective when
applied intralesionall
y
or intradermall
y
(18, 19). Both
intradermal and intramuscular routes were used in the
studies to reduce sebum secretion. According to Min et
al., the intradermal method ma
y
be more efficacious
(23). Calvisi et al. suggested that "microboto
x
," a specific
dilution of intradermal BoNT-A, ma
y
be effective for
treating mild-to-moderate acne vulgaris (19). However,
Sapra et al.'s stud
y
found that both intradermal and
intramuscular injection methods of BoNT-A were
ineffective in reducing pore size and sebum production
(22).
Ibrahim et al. reported that the use of higher
dilutions of BoNT-A results in greater diffusion areas,
leading to a higher incidence of adverse effects.
Conversel
y
, the authors noted that weakness in facial
muscles caused b
y
intradermal injection of BoNT-A was
temporar
y
and reversible. The potentiall
y
shorter
duration of the to
x
in's effect with superficial injection
of BoNT-A, as opposed to intramuscular injection, is due
to it onl
y
blocking the superficial facial and neck
e
x
pression muscles (18). Calvisi et al. discussed the
importance of precisel
y
targeting intradermal
structures, such as the sebaceous gland, with BoNT-A.
The
y
emphasized that injecting the to
x
in too
superficiall
y
would not be effective, while injecting it
Maden S
6 J Skin Stem Cell. 2024; 11(2): e145639.
too deepl
y
could lead to inadvertent paral
y
sis of the
underl
y
ing skeletal muscles (19).
Currentl
y
, there is no conclusive data indicating a
correlation between e
x
cessive or insufficient dosage of
BoNT-A and sebum production. Kest
y
and Goldberg
suggested that higher doses of BoNT-A are more
effective than lower doses in reducing sebum
production (21), but Min et al. indicated that the effect of
BoNT-A was not dependent on the dosage (23).
Additionall
y
, the efficac
y
duration varied among the
studies, which ma
y
be influenced b
y
the dosage and
brand of the BoNT-A product (19, 33).
4. Conclusions
Studies evaluating the management of acne and
reduction of sebum with BoNT-A treatment have shown
variations in dosage and duration of effectiveness. As
the effects of BoNT-A are reversible, oil
y
skin and acne
ma
y
reappear when the efficac
y
diminishes.
Furthermore, the chronic nature of acne requires
repetitive treatment, which ma
y
pose a challenge for
patients, especiall
y
from an economic perspective.
However, BoNT-A e
x
hibits potential as a treatment for
acne and oil
y
skin, with intradermal applications
showing effectiveness and minimal side effects. This
introduces a new method for addressing acne and oil
y
skin, which could significantl
y
impact the future of acne
treatment. Further studies are needed to determine the
optimal treatment method for acne and oil
y
skin due to
the diversit
y
of concentrations, dosages, and duration of
efficac
y
of BoNT-A.
Footnotes
Authors' Contribution:
Stud
y
concept and design: S.M.;
anal
y
sis and interpretation of data: S.M.; drafting of the
manuscript: S. M.; critical revision of the manuscript for
important intellectual content: S.M.
Conflict of Interests Statement:
The authors declared
no conflict of interests.
Data Reproducibility:
The dataset presented in the
stud
y
is available on request from the corresponding
author during submission or after publication.
Funding/Support:
There is no funding/support.
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