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Case Reports
. 2020 Aug 31;12(8):e10175.
doi: 10.7759/cureus.10175.

Nodular Eruptions as a Rare Complication of Botulinum Neurotoxin Type-A: Case Series and Review of Literature

Mohammed Anabtawi  1   2 , James Wege  3 , Hanya Mahmood  4 , Bahaa Alsaeed Dareen Amro  5 , Alan Patterson  3
Affiliations
Case Reports

Nodular Eruptions as a Rare Complication of Botulinum Neurotoxin Type-A: Case Series and Review of Literature

Mohammed Anabtawi et al. Cureus. .

Abstract

Nodular eruption after botulinum neurotoxin type-A (BoNT-A) treatment is exceedingly rare, and the pathogenesis is poorly understood. This case series reports three patients that developed nodular eruptions following administration of Botox® (onabotulinum neurotoxin type A (ONA) injections). These patients had undergone multiple treatments before and after development of the eruptions which were uneventful. In addition to this, we have reviewed the published literature regarding this condition and have compared and contrasted the similarities and differences with regards to the clinical presentation and treatment with our patient cohort. This case series aims to raise awareness of this rare condition, its importance in relation to patient consent and provides a simplified management approach based on our experience. Further evaluation is needed to determine treatment consensus but conducting such research may prove to be challenging due to this condition being an infrequent encounter.

Keywords: botox; botulinum neurotoxin type-a; granuloma; lump; nodules; sarcoid.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Case 1
A female patient who was treated with botulinum neurotoxin type-A (BoNT-A) to the crow’s feet area, presented after a week with those nodules at the site of injections (a), and the same patient at 32 months follow-up showing complete healing without scarring (b).
Figure 2
Figure 2. Case 2
A female patient who was treated with botulinum neurotoxin type-A (BoNT-A) to the crow’s feet, forehead and glabella areas, presented after two days with those nodules at the site of all injections (a), and the same patient at 32 months follow-up showing complete healing without scarring (b).
Figure 3
Figure 3. Case 3
A female patient who was treated with botulinum neurotoxin type-A (BoNT-A) to the crow’s feet area bilaterally and one point of injection to the left corrugator muscle, presented after three weeks with those nodules at the site of injections in the crow’s feet area bilaterally, but not at the site of corrugator injection (a), and the same patient at 32 months follow-up showing complete healing without scarring (b).
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References

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