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Topical botulinum toxin type A

Summary and key features The favorable efficacy and safety profiles of injectable botulinum toxin type A (BoNTA) for facial aesthetic procedures and for medical indications are well established. An unmet need exists for the development of systems or formulations for improved delivery of BoNTA in conditions not easily treated with injectable products. The complex “bricks and mortar” anatomy of the skin prevents effective skin penetration and…

Comparison of botulinum toxins

Summary and key features Botox® (onabotulinumtoxinA), Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), and Jeuveau® (prabotulinumtoxinA) are the four currently commercially available formulations of botulinum toxin type A in the United States. Although all four formulations are approved by the United Stated Food and Drug Administration for the treatment of glabellar lines, many off-label cosmetic indications exist, including the treatment of dynamic rhytides on other areas of the face…

DaxibotulinumtoxinA for injection (DAXI)

DaxibotulinumtoxinA for Injection (DAXI; Revance Therapeutics, Inc., Newark, CA) represents the first truly differentiated botulinum toxin formulation in the United States, the only type A botulinum toxin (BoNTA) wholly manufactured in the United States, and the first to be formulated without human serum albumin. The product is based around a 150 kDa type A core neurotoxin, produced from Hall strain Clostridium botulinum without the use of animal…

Neuronox®, Innotox®, and Coretox®

Summary and key features Neuronox® is the botulinum toxin type A (BoNT-A) product most similar to Botox® in terms of formulation, molecular composition, pharmacodynamics, and clinical performance. Innotox® is the first ready-to-use liquid type BoNT-A product, with no animal-derived materials used in its manufacturing process. Coretox® is the second BoNT-A product containing the 150 kDa neurotoxin, only without any complex protein. In addition, the manufacturing process…

Basic science of botulinum toxin E

Summary and key features Botulinum neurotoxin E is one of seven botulinum neurotoxin serotypes. Botulinum neurotoxin E has the fastest onset and shortest duration of action compared to any of the botulinum neurotoxin serotypes. Botulinum neurotoxin E is not currently approved for clinical use, although there are several studies highlighting its potential therapeutic and cosmetic benefits. Botulinum neurotoxin E’s fast onset and short duration of action…

Basic science: Myobloc®

Summary and key features BTXB is believed to have an increased radius of diffusion when compared with BTXA Rate of onset of BTXB is increased over BTXA Although dose-dependent, the duration of BTXB effect has not been shown to be equivalent or longer than that of the type A toxins. Most cosmetic dermatologists use a ratio of 1 U of BTXA to 50 U of BTXB…

Prabotulinum toxin A

Summary and key features Prabotulinum toxin A is a 900 kDa botulinum toxin type A that was approved for use in the United States in 2019 for the treatment of glabellar lines. Prabotulinum toxin A has since been similarly approved for use in Canada, the United Kingdom and the European Union. A total of 2116 subjects participated in the 5 glabellar line clinical studies that were…

Basic science: Xeomin

Summary and key features IncobotulinumtoxinA (NT 201, Xeomin™, Bocouture ™) is an effective and well-tolerated treatment for facial wrinkles that is approved for the treatment of glabellar frown lines, lateral periorbital lines (crow’s feet) and upper facial lines in many countries. IncobotulinumtoxinA does not contain complexing proteins and other impurities that are found in other commercially available botulinum toxin type A products. Complexing proteins have no…

Abobotulinum toxin A: Science and clinical usage

Summary and key features Abobotulinumtoxin (AboBoNT) is a botulinum toxin A with similar features to the other type A botulinum toxins. The accessory proteins that surround the neurotoxin protein are already dissociated in the vial after reconstitution. Is “diffusion” an issue? No—clinical studies supporting this are presented. Equivalency between AboBoNT and onabotulinumtoxinA (OnaBoNT) toxins is approximately 2.5 in terms of unit dose ratio. A true number…

Pharmacology of BOTOX® cosmetic

Summary and key features In 2002 BOTOX® Cosmetic (onabotulinumtoxinA) became the first botulinum neurotoxin FDA approved for the management of facial lines, introducing a new chapter in aesthetic dermatology. Following local injection into muscles, onabotulinumtoxinA inhibits the release of acetylcholine from motor nerve terminals and reduces muscular contractions. Botulinum neurotoxins are biological products that are formulated into distinct therapeutics, each with its own basic properties, clinical…

History of cosmetic botulinum toxin

Summary and key features 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. The first trial involved 18 patients and was published in 1992. 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. In April 2002 the US…

Update on noncosmetic uses of botulinum neurotoxins

Summary and key features Botulinum neurotoxin type A (BoNT/A) was first used clinically for the ophthalmic conditions of strabismus and blepharospasm. Over the years, the number of medical conditions for which BoNT/A is used has grown based on its local action on nerve terminals. Currently, three main BoNT/A products, onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, are approved in the United States for a select number of medical conditions.…

References and Further Reading

A. Standard textbooks of dermatopathology 1. Barnhill R.L., Crowson A.N., Magro C.: Barnhill’s dermatopathology.4th edn.2020.McGraw-Hill 2. Busam K.J.Dermatopathology.2016.Saunders 3. Elder D.E., Elenitsas R., Rosenbach M.: Lever’s histopathology of the skin.11th edn.2014.Lippincott-Williams & Wilkins 4. Patterson J.W.: Weedon’s skin pathology.5th edn.2020.Elsevier B. “Oldies but goodies”; dermpath books 5. Abenoza P., Ackerman A.B.: Neoplasms with eccrine differentiation.1990.Lea & FebigerPhiladelphia 6. Ackerman A.B., Cerroni L., Kerl H.: Pitfalls in…

Miscellaneous Remnants and Neoplasms

29.1 Nevus lipomatosus (see Fig. 29.1 ) Rare clustered papules or nodules of the buttock with onset at birth or childhood. ■ Adipose present in superficial dermis ■ Increased dermal blood vessels often Differential diagnosis 1. Lipofibroma variant of acrochordon (27.4): much more common, adult onset, usually solitary, pedunculated nodule with a narrower base. Many doctors misname these large tags “nevus lipomatosus” by mistake. 2. Goltz…

Metastatic Neoplasms to Skin

It is beyond the scope of this book to discuss all of the neoplasms that may metastasize to the skin. The more common or characteristic tumors are mentioned below. Breast cancer is the most common malignancy that metastasizes to skin, hence it is covered in its own section, 28.3 . Colon and lung cancer are also common. Breast, colon, and lung happen to be three of…

Fibrohistiocytic Proliferations and Neoplasms

27.1 Dermatofibroma (DF, benign fibrous histiocytoma, subepidermal nodular fibrosis) (see Fig. 27.1A–I ) Brownish (1.18) nodules most common on the legs (1.67), also seen on upper extremities and trunk, rarely on the head or neck, probably originating from folliculitis, arthropod bites, or some other initial inflammatory condition. Some authors prefer to think of a dermatofibroma as fibrosing dermatitis rather than a neoplasm (an –oma). Often mistaken…

Neural Neoplasms

26.1 Neurofibroma (NF) (see Fig. 26.1A–D ) Common soft , skin-colored or violaceous papules or nodules (1.129), pedunculated (1.106), or subcutaneous (1.135), may exhibit “buttonhole sign” whereby they can be invaginated with finger compression. ■ Somewhat demarcated nodule in the dermis or subcutaneous tissue of spindle cells with wavy nuclei (diving dolphins), sometimes in strands said to resemble shredded carrots ■ Pale “bubblegum” pink stroma, mucinous…

Vascular Proliferations and Neoplasms

Vascular neoplasms and proliferations in this chapter are mainly made up of endothelial cells that line blood vessels or lymphatics. These cells are generally positive for factor VIII-related antigen, Ulex europaeus lectin, CD31, CD34, FLI-1, and ERG. 25.1 Hemangioma and vascular malformation (see Fig. 25.1A–G ) Pediatric dermatologists split most vascular neoplasms into two groups, true hemangiomas and vascular malformations, based upon the tendency of true…