Facial Blanching Due to Neurotoxins: Proposed Mechanisms

Background The effect of perceived facial blanching with neurotoxin therapy has been described in the literature and has been used to treat the undesirable facial flushing of Frey's syndrome. Patients rarely report it as a complication after cosmetic injection, but it can be distressing. Object...

Full description

Saved in:
Bibliographic Details
Published in:Dermatologic surgery 2013-01, Vol.39 (1pt1), p.24-29
Main Authors: Khan, Tanya T., Herne, Kathleen, Dayan, Steven H., Woodward, Julie A.
Format: Article
Language:English
Subjects:
Adult
Botulinum Toxins, Type A - adverse effects
Botulinum Toxins, Type A - metabolism
Botulinum Toxins, Type A - pharmacology
Erythema - drug therapy
Face - blood supply
Female
Humans
Neurotoxins - adverse effects
Neurotoxins - metabolism
Neurotoxins - pharmacology
Pallor - chemically induced
Signal Transduction - drug effects
Skin - blood supply
Sweating, Gustatory - drug therapy
Vasoconstriction - drug effects
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The effect of perceived facial blanching with neurotoxin therapy has been described in the literature and has been used to treat the undesirable facial flushing of Frey's syndrome. Patients rarely report it as a complication after cosmetic injection, but it can be distressing. Objectives To elucidate the proposed mechanism(s) of this unusual vasculocutaneous phenomenon, we reviewed normal physiologic responses to heat stress and the role of cholinergic neurotransmission in modulating cutaneous vascular tone in the context of the literature. Materials/Methods We report a case of a 32‐year‐old woman who complained of white patches on her forehead at sites of abobotulinumtoxinA injections administered 2 weeks before presentation. Results Acetylcholine is a primary mediator of cutaneous vasodilatation; certain co‐transmitters modulate its effect. Chemical denervation by botulinum toxin (BoNT) appears to interfere with these normal signaling pathways and can provide symptomatic relief to patients with undesirable facial flushing. Conversely, it may create an unwanted cosmetic effect in patients who desire isolated muscle paresis. Conclusions Skin sites injected with BoNT type A may not experience the expected decrease in cutaneous vessel tone associated with higher body temperature. The exact mechanism remains unclear.
ISSN:1076-0512
1524-4725
DOI:10.1111/dsu.12057