Not Just for Wrinkles: Botox for Atopic Dermatitis

Researchers are exploring the possibility of using botulinum toxin (Btx) as an adjuvant treatment for resistant forms of atopic dermatitis. BTx injections have shown promise in preventing dermatitis-like lesions in laboratory animals.

As many patients and dermatologists can attest, atopic dermatitis remains one of the most common yet confounding skin conditions. Contact with a foreign body or substance produces an allergic reaction and localized inflammation that leads to the secretion of histamine, responsible for the itchy sensations. The repeated scratching to relieve these pruritic symptoms results in the characteristic swollen, reddened or thickened appearance of the affected areas.

While atopic dermatitis generally resolves by itself, a number of patients experience persistent symptoms that require treatment. Individuals living with this actopic dermatitis are burdened with constant inflammation and itch, which often leads to eczematous skin that is prone to infection and further perpetuates the symptoms. No single treatment has been shown to be universally effective; what works for some may not be as helpful for others. Steroids, creams, light therapy, silk clothing, salt or even dilute bleach baths are among the numerous prescribed treatments that come with varying degrees of success.

Clinicians now recognize that a multi-pronged approach is best for dealing with atopic dermatitis.  Combining an identified effective treatment with a preventative method is routinely recommended. For patients with resistant forms, adjuvant or additional therapies are considered to relieve the most acute symptoms that can lead to infectious complications.

Botulinum toxin (BTx) is most commonly used for the treatment of wrinkles; but beyond its cosmetic applications, BTx is also routinely used for the relief of chronic muscle pain, spastic conditions, and even excessive sweating of the palms or armpits (hyperhidrosis).

Researchers are now looking at whether BTx can be of help for those with recalcitrant forms of atopic dermatitis. An article in Dermatologic Surgery describes how South Korean scientists tested BTx on induced lesions similar to atopic dermatitis in laboratory animals. Researchers injected BTx into the affected areas and noted a significant reduction in inflammation and swelling.  Similarly, they noted marked changes under the microscope, indicative of a retardation of the cellular processes involved in dermatitis.

This study indicates the possible role for BTx as that adjuvant form of treatment in atopic dermatitis, but additional research is needed. The cost of multiple BTx injections in large areas remains prohibitive; moreover, the pain of these numerous injections into the skin may indeed scare off interested patients.  Perhaps in the near future we will see topical creams or gels infused with BTx available to those burdened with the constant itching and scratching.

Written By: Jay Martin, M.D.

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