Diluted intradermal botulinum toxin A injections (Microbotox) may be effective for treating patients with mild to moderate acne vulgaris and erythematotelangiectatic rosacea, according to findings from a study published in the Journal of Cosmetic Dermatology.

Researchers evaluated the effectiveness of a specific dilution of onabotulinum toxin A in 50 patients (mean age, 34.5 years [range, 18-55]; 40 women) from January 2017 to December 2017.

Botulinum toxin solution was reconstituted with a vial of 50 Botox units (UB) of onabotulinum toxin A with 0.75 mL saline and 0.5 lidocaine (0.5%) without adrenaline for dilution. The patients’ cheeks were systematically injected with multiple tiny blebs of diluted botulinum toxin at repeated intervals, referred to as Microbotox.


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Among the 35 patients with mild to moderate acne, all had a pronounced positive effect from the treatment, such as no “shine” and pronounced sebum secretion, narrowing of pores, and significant “smoothing” of postacne scars and skin furrows, according to the researchers. The participants had significant improvement in Michaelsson acne score (MAS) (mean improvement score, 55.48%), although 2 patients did not respond well to the treatment.

Initial improvement was observed regarding reductions in the papules and pustules 14 days after the treatment. A significant decrease in mean papule and pustules counts (MAS medium improvement >55.4%) occurred after 4 weeks and continued for 4 to 5 months. Similar decreases were observed in MAS.

Regarding the 15 patients with refractory erythematotelangiectatic rosacea, all received 2 treatments of intradermal botulinum toxin injections at 14-day intervals. The patients achieved a good aesthetic result by 1 week after the second treatment, with no major adverse events. Some participants had mild pain during the treatment and localized bruising afterward, which disappeared after 1 week.

Erythema and flushing were reduced after 2 weeks, and significant improvement of skin quality occurred (Dermatology Life Quality Index medium improvement score >47.73). A touch-up injection session was needed for all participants, and none had a worsening of their rosacea.

All patients had a decrease in flushing of rosacea symptoms based on the Global Aesthetic Improvement Scale. The results remained stable 4 months after the treatment.

The study authors concluded by stating that their research may represent the largest case series to demonstrate that Microbotox injections safely and effectively “reduce erythema and flushing in rosacea.” They also suggested that “Larger, controlled, randomized studies are needed to identify the optimal number of units required for a longer and lasting effect for this particular novel dilution.”

Reference

Calvisi L, Diaspro A, Sito G. Microbotox: a prospective evaluation of dermatological improvement in patients with mild-to-moderate acne and erythematotelangiectatic rosacea. J Cosmet Dermatol. Published online March 21, 2022. doi:10.1111/jocd.14692