Neutralizing Antibodies to Botulinum Toxin Type A as a Secondary Treatment Failure: A Case Report from Mumbai, India.
Botulinum toxin use in aesthetic medicine for treatment of facial rhytids is common and has become more and more popular in India in recent times. Botulinum toxin is produced by clostridium botulinum which is an anaerobic, spore forming, rod
shaped bacteria. The botulinum toxin complex contains a 150 KD neurotoxin together with a complex additional protein.
The neurotoxin is cleaved by the clostridial proteases into heavy and light chain. The heavy chain after cleavage binds to
gangliosides and a protein receptor on the presynaptic nerve ending, whereas the light chain blocks the release of acetylcholine, leading to a dose dependent weakening of the target muscle.
There are the seven distinct serotypes of botulinum toxin A-G, of which A and B are used clinically. Various commercially available botulinum toxin type A commonly used in India are Incobotulinum-Xeomin®, Onabotulinum-Botox®, and Abobotulinum-Dysport®; respectively. Botulinum toxin was first used clinically in 1970s in ophthalmology to treat strabismus, and over last two decades has gained widespread use in conditions requiring inhibition of excessive muscle spasm.
Medical indication of BoNT include movement disorders like spasticity, cervical dystonia, urological disorders like overactive bladder, dermatology conditions like hyperhydrosis and cosmetic indications of facial
rhytids. The indicated clinical conditions are chronic in nature, and BoNT
effects do not last more than few months; patients need to be treated repeatedly.
Over the last 20-years botulinum toxin has gained popularity especially for cosmetic and aesthetic indications.
However, there some patients who stop responding to the BoNTA
injections due to a variety of reasons, including emergence of immunoresistance as a result of neutralizing antibodies.
Trichol Cosmetol Open J. 2022; 5(1): 4-9. doi: 10.17140/TCOJ-5-117