Effect of the Refrigerator Storage Time on the Potency of Botox for Human Extensor Digitorum Brevis Muscle Paralysis

Background and Purpose

It is recommended that Botox be used within 5 hours of reconstitution, which results in substantial quantities being discarded. This is not only uneconomic, but also inconvenient for treating patients. The aim of this study was to determine the potencies of Botox used within 2 hours of reconstitution with unpreserved saline, the same Botox refrigerated (at +4℃) 72 hours after reconstitution, and during the next 4 consecutive weeks (weeks 1, 2, 3, and 4). This comparison was used to determine the length of refrigeration time during which reconstituted Botox will maintain the same efficacy as freshly reconstituted toxin.

Methods

Individual paralysis rates in the extensor digitorum brevis (EDB) compound muscle action potential (CMAP) amplitude and area were measured 1 week after injecting fresh reconstituted 2.5 MU of Botox on one side of the foot, and when the same quantity of Botox that had been refrigerated for a designated time (i.e., 72 h, or 1, 2, 3, or 4 weeks) into the other side of the foot. The EDB CMAP amplitude and area at 12 and 16 weeks postinjection were also measured to compare the efficacy durations in all five comparative groups.

Results

Ninety-four volunteers were divided into five groups according to the refrigerator storage time of the second Botox injection. The paralysis of the EDBs was significant for each injection of Botox, both fresh and refrigerated, with no statistically significant differences between them, regardless of the refrigeration time. There was a tendency toward increased CMAP amplitude and area at 12 or 16 weeks postinjection (p<0.0001). The duration of effective muscle paralysis did not differ significantly throughout the 16-week follow-up period between all five groups.

Conclusions

The potency of reconstituted Botox is not degraded by subsequent refrigeration for 4 weeks. However, there are definite concerns regarding its sterility, and hence its safety, since multiple withdrawals from the same vial over long periods can introduce bacterial contamination.     

Pyoderma gangrenosum‐like lesions provocated by botulinum injections

Botulinum toxin (BoNT) is a valuable therapeutic tool with several medical indications and the most popular of all cosmetic procedures worldwide. This is the reason for the growing number of unregistered products that may be the reason for adverse reactions. We present a case of a 51‐year‐old woman, who developed a pyoderma gangrenosum‐like reaction at injection sites after the administration of an unregistered BoNT product by a beautician. The clinical course, the morphology of the lesions, the result of histopathological biopsy, and the response to the treatment meets the criteria for diagnosis of pyoderma gangrenosum. The case presented by us is the first adverse reaction of this type after BoNT administration.     

Compensatory hyperhidrosis: a consequence of truncal sympathectomy treated by video assisted application of botulinum toxin and reoperation

Hyperhidrosis is a debilitating condition characterised by sweating that exceeds the need of normal thermoregulation. Surgical management of primary hyperhidrosis by upper dorsal sympathectomy is the treatment of choice for intractable hyperhidrosis, however, paradoxically it may be followed by troublesome compensatory hyperhidrosis in a significant number of patients. The frequency of compensatory hyperhidrosis often reflects the extensiveness of the denervation. We report for the first time the successful treatment of a patient who developed compensatory hyperhidrosis following sympathectomy using video assisted extension of the sympathectomy by application of botulinum toxin (BTX-A). In addition, this case highlights the use of botulinum toxin as a guide for the potential successful management of compensatory hyperhidrosis prior to definitive extension of a sympathectomy.     

Cohort study on patient response to botulinum toxin cosmetic therapy

Background   Botulinum toxin (BTX) therapy is currently the most popular cosmetic procedure in the United States. However, few studies exist regarding post-procedure perceptions of the patients' BTX therapy.
Objective    The aim of this cohort study was to determine patients' responses from pre- to post-BTX treatment experience.
Methods and materials    One hundred twenty-three BTX patients of six different dermatologic cosmetic practices in various boroughs of New York and Long Island in the state of New York completed the questionnaire. Six hundred eighty-three surveys were sent out, and 123 completed surveys were obtained. Numerous questions were asked regarding how patients felt and responded towards the overall procedure of their BTX therapy.
Results    Eighty-eight percent of patients were satisfied or extremely satisfied with their dermatologists. Sixty-five percent of patients felt over 60% improvement in areas treated. Fifty-eight percent of patients anticipated making repeat visits, whereas the biggest concern for returning was due to the expensive cost of BTX.
Conclusion   Our study correlated with previous studies done on retention rate of BTX cosmetic patients and satisfaction level on areas treated. The cost of BTX remained one of the primary concerns for repeat visits. Most patients were happy with their visits to the dermatology offices for BTX procedure, although things can be done to further enhance their visits and the likelihood that they will return.