Use of Botulinum Toxin in Dermatology

Botulinum toxin (BoNT), initially approved for strabismus in 1989, has expanded its therapeutic applications into dermatology. This review assesses BoNT’s potential role in treating various dermatological conditions, including Hidradenitis Suppurativa (HS), rosacea, androgenetic alopecia, plaque psoriasis, and primary hyperhidrosis. Studies suggest BoNT’s efficacy in HS, with reductions in inflammation and pain, yet controlled trials are necessary for conclusive evidence. In rosacea, BoNT injections mitigate erythema, but mechanistic understanding remains incomplete. Androgenetic alopecia studies reveal increased hair density following BoNT injections, possibly through dermal papilla modulation and scalp muscle relaxation. BoNT shows promise in plaque psoriasis, likely by mitigating neurogenic inflammation. In primary hyperhidrosis, BoNT significantly reduces sweat production and severity, offering a viable second-line treatment. Despite BoNT’s potential, its use requires caution due to associated risks. Dermatologists must balance on-label and off-label applications for optimal patient outcomes. While existing evidence underscores BoNT’s therapeutic potential, rigorous clinical trials are warranted to establish safety and efficacy definitively. Continued research is imperative to refine BoNT therapy and expand its dermatological applications. This review highlights the need for ongoing investigation and consensus-building to maximize BoNT’s benefits in dermatology.