Clinical applications of botulinum toxin as a versatile agent.

In present-day medicine, botulinum toxin injections (known under brands  Botox (Allergan), Dysport (Galderma) and Xeomin (Merz), are widely used for various cosmetic procedures. Many people have developed an association of Botulinum toxin injections only with reduction of wrinkles and achievement of a youthful look. However, medical cosmetology is just a small niche of what botulinum toxin is able to do. It is very versatile and can be essential in different conditions like migraines, spasticity, blepharospasm (eye twitch), overactive bladder, and hyperhidrosis (extensive sweating underarms).

In microbiology, botulinum toxin is known as “Miracle poison” and considered as one of the most poisonous biological substances to a human body. It is a neurotoxin which is produced by anaerobic gram-positive bacterium Clostridium botulinum. Even though the  C. botulinum has different strains, in medicine, only A and B are used. The general mechanism consists of neurotoxin blocking the release of acetylcholine at the neuromuscular junction. As a result, muscles are unable to contract and muscle paralysis occurs.  Besides blockage of acetylcholine release, botulinum toxin is also able to block the release of pain, glutamine as well as substance P (inflammatory mediators). As a result, botulinum toxin injections are used for patients who suffer from migraines. 

30-gauge 1-inch needle is used to inject botulinum toxin into affected areas. The amount of dosage depends on its purpose and unique to each patient. Moreover, the mass of muscle where neurotoxin will be injected also determines the given dosage. The general rule is: the greater the muscle mass, the greater amount of dosage is. But, dosage can be reduced if patient has already preexisting medical conditions. 

It is suggested to go home and rest after receiving neurotoxin. Strenuous activities are not recommended for the first few days.  Some of the adverse effects after neurotoxin injection may include swelling, bruising, minor discomfort, and muscle weakness of the surrounding muscles. 

In 1970s, scientists began using botulinum toxin as a treatment method for strabismus (“crossed eyes”) which is a condition of one looking directly at the viewing object while another eye is misaligned either inward, outward, or downward. The clinical trials showed positive results of botulinum toxin being able to reduce wrinkles in glabella (the skin between eyebrows and above the nose area). 

Nowadays, the usage of botulinum toxin plays a significant role in current clinical applications. This biological substance helps to manage hemifacial spasms, strabismus and focal dystonias, and other spasmic disorders. Moreover, it also helps to reduce migraines and hyperhidrosis. It is also a promising alternative method to treat patients with chronic anal fissures. Achalasia, the condition that leads to having a backup of food in oesophagus, can also be treated with botulinum toxin. Lastly, in cosmetological niche, neurotoxin is used in correcting lines, wrinkles, and creases on face, chin, and neck.