BOTULINUM TOXIN in Visual Studio .NET

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CHAPTER 22 BOTULINUM TOXIN
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BOTULINUM AND HAIR GROWTH CONTROL
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Focal hair loss following BTX-A treatment for blepharoplasm and oromandibular dystonia has been reported, but remains controversial100,101 Several theories have been suggested to explain this observation, specifically the fact that hair follicles contain cholinergic receptors, which are essential signaling elements for nerve transmission that send growth signals to hair follicles102 When inhibited by BTX, those receptors may lead to hair loss103 Hair loss has also been described in conditions related to peripheral nerve dysfunction such as diabetic peripheral neuropathy, myxoma of the nerve sheath, and after occipital nerve block with corticosteroid BTX could have the same effect through chemodenervation These observations need to be studied before arriving at a conclusion or establishing a new indication for BTX Cutrer and Pittelkow have actually reported regrowth of hair rather than loss after Botox was administered for alopecia areata, extending the debate over whether Botox actually causes hair regrowth or loss104
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FIGURE 22-31 A The iodine starch test solution is made by combining 9 parts of iodine with 1 part of castor oil B The iodine solution is then applied to the affected area using a swab C Potato starch is sprinkled over the iodine solution (continued ) gland secretions are controlled by various neuropeptides, with substance P playing a significant role94 BTX-A blocks substance P, TRPV-1, and CGRP, which are important mediators in inflammation, and therefore helps decrease the inflammatory aspect of acne development
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BOTULINUM TOXIN AND CHEMICAL LIPOSUCTION
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Obesity is a medical problem with obvious cosmetic implications Liposuction, gastric volume reduction, laparoscopic banding, lipase inhibitors, and mesotherapy are all methods employed in the
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overall skin tone and texture One study indicated that CO2 ablative laser resurfacing combined with BTX-A provided a stronger and longer-lasting effect107 Within many cosmetic practices, BTX-A is now a part of the standard resurfacing protocol The synergistic effects of BTX-A and other rejuvenation procedures can extend to intense pulsed light protocols In one study, the combined effect of intense pulsed light and BTX-A produced a more pronounced global aesthetic improvement in reducing crow s feet, telangiectasia, pore size, and lentigines, as well as ameliorating facial skin texture as compared with the use of intense pulsed light alone108
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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RESISTANCE TO BOTULINUM TOXIN
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Development of Antibodies
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Botulinum neurotoxins may be immunogenic, and antibodies may inactivate the molecule The BTX molecule is composed of a light chain and a heavy chain The toxin is embedded in a protein complex that protects the toxin s binding site until the desired pH is reached and the toxin is released Antibodies to this critical binding site on the heavy chain of the BTX molecule will prevent binding of the toxin to its receptor, thereby crippling the actions of the toxin Neutralizing antibodies have been reported in patients treated with high doses of BTX for neurologic disorders such as cerebral palsy It is important to understand that there are many types of antibodies that can interact with BTX; however, the only antibodies that can affect the efficacy of the toxin are neutralizing antibodies Antibodies may develop to BTX that are inconsequential to the patient, yet the antibodies that are capable of neutralizing the toxin are a concern as they have the potential to decrease the efficacy of the toxin By definition, antibodies that neutralize BTX-A would not neutralize BTX-B and vice versa Patients who develop antibodies to BTX-A can still enjoy the benefits of BTX-B For this reason, it is recommended that practitioners have several different BTX serotypes available on the market The incidence of antibody-mediated resistance to BTX, as determined by the mouse lethality assay, is reported between 3% and 95% and is accepted generally to be approximately 5% The only apparent symptom of the development of antibodies is lack of response to
FIGURE 22-31 (continued ) D Sweat turns the starch black, delineating the affected areas E This test is useful to determine which areas to inject In this patient, the ngertips can be avoided because the starch iodine test indicates that there is no sweating on the ngertips
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