Acne Daily
Injectable Neuromuscular Paralytics For Adult Acne Control
Posted Tuesday, September 15, 2009
Recent comments from physicians and a published medical paper from last year have indicated that the muscle paralysing agent Botox, when injected just into the skin, helps control acne breakouts in difficult cases. In addition, larger pore sizes are reduced.
Acne is caused by the skin's sebaceous glands which make too much sebum or oil. The sebum then clogs the pores which subsequently leads to an 'oven' incubating bacteria.. When enough bacteria multiply, inflammation and a pustule is then formed. The injection of an agent such as Botox is believed to help control acne by blocking the chemical acetylcholine in the skin's dermis. Since acetylcholine is a chemical which helps the skin produce sebum, less of it is made and acne breakouts decrease. In addition, by paralyzing the little muscles that surround a skin's pore their relaxation result in a less expanded pore size.
Putting small amounts of Botox into the skin requires precision in the injection technique. Since the skin is very thin, 1/25th of an inch in thickness, the injections need to be just into this layer and not deeper. If the injections slip past the skin, facial muscles may be weakened and one's facial expressions altered.
The only published medical study on the effects of Botox on acne appeared in the August 2008 issue of the Journal of Drugs in Dermatology entitled 'Use of intradermal botulinum toxin to reduce sebum production and facial pore size.' Dr. Anil Shah reported his experience on twenty patients which showed that seventeen of them had a significant reduction in their breakouts one month after being injected. While the study size was small and the follow-up brief, these preliminary results were encouraging. Dr. Shah cautions, however, that this form of acne treatment isn't for everyone. He recommends that its use be for patients over 20-years-old who have more stable hormonal levels.
Adult acne can be a difficult problem. Many treatments are available including antibiotics, topical prescription and non-prescription topical creams, light and laser therapies, and Accutane. Accutane is the only medication that works directly at the gland level to reduce oil production but it has serious side effects and is highly monitored. In my Indianapolis plastic surgery practice, my aestheticians regularly treat difficult acne cases and some patients can be resistant to many of the common treatments. The use of an injection approach would be very attractive like steroid injections.
Botox remains an interesting treatment option for recurrent adult acne cases. Be aware, however, that its use is an off-label, non-FDA approved application of Botox and most of the current medical evidence is more speculative than proven. I have yet to see a published clinical study that evaluates its effects in a larger number of patients with longer follow-up. But the concept is theoretically appealing and it seems to have no significant risks.
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Dr Barry Eppley is a board-certified premiere plastic surgeon in Indianapolis, Indiana where he practices at his Ology Spa locations at Clarian North Medical Center in Carmel Indiana and at Clarian West Medical Center in Avon Indiana. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com. Dr. Eppley can be heard weekly on his radio show, Doc Chat, on WXNT 1430 AM every Saturday afternoon.
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