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Review
. 2021 Nov 19;13(11):817.
doi: 10.3390/toxins13110817.

Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Nark-Kyoung Rho  1   2 , Young-Chun Gil  3
Affiliations
Review

Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Nark-Kyoung Rho et al. Toxins (Basel). .

Abstract

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.

Keywords: acetylcholine; acne vulgaris; botulinum toxins; cholinergic receptors; non-neuronal cholinergic system; oily skin; sebaceous glands; seborrhea; sebum.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) A young Korean male with facial seborrhea appearing greasy and shiny, accompanied by enlarged pores on the cheeks; (b) Histologic findings of the facial skin of excess sebum secretion. Note the lobules of mature sebaceous glands and a dilated follicular infundibulum filled with keratinous material (nose, hematoxylin, and eosin staining, ×50).
Figure 2
Figure 2
Increased lipid synthesis in cultured sebocytes after treatment with 10 nM of acetylcholine. Intracellular lipids are detected in acetylcholine-treated sebocytes by lipid staining (Photos are used with the kind permission of Dr. Myung Im, MD, IM Dermatology Clinic, Daejeon, Korea).
Figure 3
Figure 3
Changes in sebum secretion relative to baseline at each follow-up point after injection of botulinum toxin type A into the forehead. ABO30: abobotulinumtoxinA 30 units; ABO45: abobotulinumtoxinA 45 units; ONA10: onabotulinumtoxinA 10 units; ONA20: onabotulinumtoxinA 20 units. Graph was plotted using the data from [32,34].
Figure 4
Figure 4
A young Korean female with facial seborrhea and acne on the forehead. Two weeks after intradermal injection of 12 units of onabotulinumtoxinA, a significant improvement was observed.
Figure 5
Figure 5
Pathogenetic factors of acne that can be inhibited by botulinum neurotoxin type A. α7nAChR: alpha 7 nicotinic acetylcholine receptor; AA: arachidonic acid; BoNTA: botulinum neurotoxin type A; COX-2: cyclooxygenase-2; Epi: epinephrine; NE: norepinephrine; SP: substance P; TRPV1: transient receptor potential vanilloid subtype 1.
See this image and copyright information in PMC

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