Tiny
amounts of botulinum, the world's deadliest toxin, can eliminate wrinkles
around the eyes, and it appears to be so safe many doctors inject themselves,
researchers said.
Botulinum, the
bacterial toxin that can kill if consumed in contaminated food, has been
approved for cosmetic purposes only in Canada, according to a report presented
at the summer scientific meeting of the American Academy of Dermatology.
Doctors use
botulinum to eliminate the tiny wrinkles around the eyes known as "crow's
feet," and the treatment is gaining widespread use, said Dr. Richard Glogau,
clinical professor of dermatology at the University of California, San
Diego.
The Food and
Drug Administration has approved botulinum toxin for a number of medical
conditions, including certain eye disorders and painful cervical dystonia,
a neck muscle disorder. In Canada, botulinum is approved as a treatment
for frown lines in the brow.
Glogau said
botulinum toxin blocks nerve signals transmitted from the brain to the
muscle, causing paralysis of the muscle.
Since the muscles
in the brow and around the eyes are known to cause wrinkling, botulinum
makes those muscles relax, removing the wrinkles.
However, botulinum
treatments have to be repeated, usually after a few months when the muscles
shrug off the toxin.
"I would expect
that about 10 to 15 percent of the dermatologists here have recently used
botulinum injections to eliminate facial wrinkling,"
Glogau said
during a press briefing at the conference. Dr. Marianne O'Donoghue concurred
and said, "I think that's about the right number." She suggested that doctors
inject themselves to improve their appearance.
Glogau said while
application of botulinum for treating wrinkles is considered "off-label"
use -- but not illegal --doctors are working to fine-tune the therapy.
Early in the
use of botulinum for crow's feet, he said, doctors injected the areas close
to the eye in three places.
Now most inject
one area and gently massage the toxin to affect the rest of the wrinkling.
Glogau said in practiced hands there is little chance botulinum treatments
can be harmful to the patient.
The chance of
overdose is even more remote, he said. Botulinum is so diluted -- and so
expensive -- that before a fatal overdose could occur a doctor would likely
bankrupt himself, he said.
In the hands
of unskilled physicians, however, there is a danger that use of botulinum
could cause some disfiguring appearances, said Dr. Nicholas Lowe, clinical
professor of dermatology at the University of California, Los Angeles,
School of Medicine.
Too much botulinum
or the misplacement of injections can cause lips to droop, a patient to
drool, and create a number of other complications, Lowe said.
"You can make
a patient look as though he has had a stroke and that condition can persist
for months," Lowe said.
Nevertheless,
Lowe added, the future looks bright for use of botulinum in numerous treatment
areas, including using it in combination with other treatments.
He and Glogau
both use botulinum toxin in combination with laser resurfacing. Glogau
said that when the laser resurfacing treatment takes place, damage is caused
to the skin in order to promote collagen growth.
But while the
skin heals, wrinkling can actually be exacerbated.
Use of botulinum
can keep those facial muscles responsible for the wrinkling relaxed until
after healing is complete.
Lowe said he
expects botulinum for cosmetic approaches will receive numerous government
approvals in the next few years. That could mean the treatments will be
covered by insurers and other third-party payers. Glogau said the controlled
studies required by regulators for approval are ongoing, but as doctors
and patients learn about the positive effects of botulinum toxin, the demand
for the procedure is running ahead of government actions.
"Botulinum toxin
has truly revolutionized the treatment of aging skin, especially wrinkles,"
Glogau said.
"However, we
have only begun to tap into the medical uses for the toxin."
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