Topical Botulinum Toxin is Coming!

Botulinum toxin first came into clinical use in the early 1990s. Since then it has become very widely used, and is a billion dollar business. It acts by blocking the transmission of the signal from the nerve to the muscle, so the muscle is not stimulated and does not contract. Fortunately, the product is specific for the motor nerves and it does not affect the sensory nerves. Thus there is no localized loss of sensation or numbness associated with the use of botulinum toxin.

From the onset, the product has been injected into the target muscles. The toxin molecule is large, and it is difficult to get large molecules through the skin intact. Furthermore, in many areas the product must be placed precisely, so as not to affect muscles that would give an undesireable effect. Droopy upper lids or an assymetrical smile are examples of unwanted botulinum toxin effects.

Because of these obstacles it was felt to be very unlikely that a topical from of botulinum toxin would become available. However Revance Therapeutics, a startup biotechnology company, appears to be on the way to solving these problems. They have developed a product that does appear to be able to penitrate intact skin. It is designed to be applied in the physician's office and be left in place for a period of time.

Current reports are that 80% of the patients have a response at 4 weeks, and the effect lasts 4-5 months. The product is only useful for superficial muscles, and is best for an area where there are not nearby muscles that could cause problems if affected. Currently it is being tested in the crow's feet area. Other areas where it could conceivably be used are fine wrinkles around the mouth, the forehead and muscle bands on the neck. It would also be nice if it could be used to treat increased sweating (hyperhidrosis) on the hands, feet and armpits. There has also been speculation that it might have some benefit in acne, decreasing pore size and treating crepey skin on the face and perhaps other areas.

This product is still in a relatively early stage of development, but currently there do not seem to be any major obstacles in front of it. Perhaps in the next 1-2 years we'll actually be able to get our hands on it and see how well it works.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Comments

[San Diego Cosmetic Surgeon]

For those who want to know how Botulinum toxin works. I'd recommend reading this. Highy informative. Thanks for the post.