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History of cosmetic botulinum toxin
Summary and key features
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In the mid-1980s Dr. Jean Carruthers noticed a concomitant improvement in glabellar rhytides in a patient treated with botulinum toxin (BoNT-A) for blepharospasm.
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The first trial involved 18 patients and was published in 1992.
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By 2002, open-label studies of more than 800 patients confirmed the efficacy and safety of BoNT-A in the treatment of hyperfunctional facial wrinkles.
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In April 2002 the US Food and Drug Administration approved BoNT-A for the nonsurgical reduction of glabellar rhytides.
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Cosmetic BoNT-A is now used for hyperkinetic lines in the face, neck, and chest, for facial sculpting, and as an adjunct to other rejuvenating modalities.
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Onabotulinumtoxin-A has since gone on to receive approval for 30 indications in more than 97 countries.
Introduction
It is in the nature of History that details will change but the broad sweep of the topic if accurately recorded does not change in its essence and so we take the liberty of repeating the history chapter from the previous edition and will then add to that:
The discovery of “sausage poison” and subsequent identification of Clostridium botulinum as the bacterium responsible has had an enormous and lasting impact on the field of cosmetic dermatology. As is often the case in medicine, a series of serendipitous discoveries—coupled with astute clinical observations—unlocked the potential of botulinum toxin (BoNT-A) and led to significant medical gains ( Tables 2.1 and 2.2 ). Once hailed as a promising breakthrough for a handful of muscular disorders, BoNT-A has since become a veritable mainstay of the cosmetic practitioner, its popularity growing exponentially to become the most requested procedure in facial rejuvenation.
TABLE 2.1
Timeline of Clinical Discovery
| Late 1700s | Outbreaks of deadly illness from contaminated foods sweep across Europe |
| 1793 | Biggest outbreak in Wildbad, Southern Germany |
| 1811 | “Prussic acid” named as culprit in sausage poisoning |
| 1822 | Dr. Justinus Kerner publishes monograph of “sausage poison” and accurately describes botulism |
| 1895 | Professor Emile Pierre Van Ermengem identifies Clostridium botulinum as causative agent of botulism |
| 1895–1915 | Seven serotypes of toxins are recognized |
| 1928 | Dr. Herman Sommer isolates most potent serotype: BoNT-A |
| 1946 | Carl Lamanna and James Duff develop concentration and crystallization techniques subsequently used by Dr. Edward J. Schantz at Fort Detrick, Maryland, for possible biological weapon |
| 1972 | Dr. Schantz takes his research to the University of Wisconsin, where he produces the large batch of BoNT-A that remained in clinical use until December 1997 |
BoNT-A , Botulinum toxin type A.
TABLE 2.2
Timeline of Therapeutic Development and Use
| Late 1960s–early 1970s | Dr. Alan Scott begins animal experimentation with BoNT-A supplied by Dr. Schantz |
| 1973 | Dr. Scott publishes the first report of BoNT-A in primates |
| 1978 | FDA grants approval to begin testing small amounts of the toxin (Oculinum) in human volunteers |
| 1980 | Landmark paper demonstrating that BoNT-A corrects gaze misalignment in humans |
| 1988 | Allergan Inc. acquires rights to distribute Dr. Scott’s Oculinum in the United States |
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BoNT-A , Botulinum toxin type A; FDA, US Food and Drug Administration.
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