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More on BOTOX for Rosacea Flushing

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  • More on BOTOX for Rosacea Flushing

    3. BOTOX® Injections

    Acetylcholine is a major neurotransmitter that is released by certain types of nerves (sympathetic, parasympathetic, and sensory nerves). After being released from nerve endings, acetylcholine can bind to sweat glands (resulting in sweat formation), and blood vessels (resulting in dilation). Lately, there has been extensive research into the role of acetylcholine in nerve-mediated disorders, especially those that are accompanied by skin flushing and sweating.

    BOTOX® treatment is extremely effective at blocking the release of acetylcholine from nerve endings in the facial skin (BOTOX® is a vaccine derived from botulism bacteria; Botulinum Type A, Allergan). BOTOX® treatment consists of superficial injections into the affected area of skin. The safety and effectiveness of BOTOX® in the treatment of neural-mediated disorders of the facial skin has been extensively studied (review of the current medical literature on Medline indicates that several dozen peer-reviewed clinical studies have been performed on hundreds of patients). These studies indicate that BOTOX® can safely be injected into the nose, cheeks, chin, forehead, temples, and certain portions of the eye area and eyelids. Currently, this vaccine is being used to treat facial muscle spasms, wrinkles, frown lines, eye twitching, nostril flaring, and crossed eyes. Additionally, BOTOX® has been used extensively to treat neural flushing and sweating disorders of the face (i.e., Frey Syndrome). Some of these studies have been highlighted in a medical review article in the Archives of Neurology (1999), “Botulinum Toxin in the Treatment of Neurological Disorders of the Autonomic Nervous System”. (47)

    There is recent clinical evidence indicating that skin flushing to internal body heating can be completely abolished by cutaneous BOTOX® treatment. (48) Dr. Dean Kellogg and colleagues demonstrated that BOTOX® treatment of normal human skin completely blocked active skin flushing that is caused by increases in internal body temperature. (48) Interestingly, this study also suggests that BOTOX® may block other dilator neurotransmitter substances that may be co-released with acetylcholine.

    Over the last year, I have received five anecdotal reports from two physicians and three patients indicating that BOTOX® treatment significantly reduced certain forms of facial flushing. One physician reported that a patient treated on the tip of the nose for nostril flaring, no longer flushed in the treated area to certain neural stimuli such as overheating, exercise, anger, and embarrassment. A second physician reported that BOTOX® treatment of the left cheek of one patient (for hemi-facial muscle spasm), resulted in significant reductions in the patient’s flushing response to hot environments, overheating, and stress. This reduced flushing response was only observed in the treated cheek area. Three other subjects who have been treated for wrinkles and frown lines have reported decreased skin flushing responses in the BOTOX® treated areas.

    While the above studies and anecdotal reports show promise for BOTOX® treatment of certain forms of skin flushing, it must be noted that these results are not permanent. In the treatment of superficial neural disorders, the vaccine’s effectiveness may wear off in 5 to 9 months. Additionally, the cost of BOTOX® may limit the use of this therapy (it is quite expensive). I currently do not recommend BOTOX® specifically for rosacea or facial flushing because there are too many “unknown variables”; but physicians who are already treating rosacea patients or pre-rosacea flushers for other conditions, should publish their findings.

    Some Intriguing BOTOX® Questions:

    • Could a series of BOTOX® treatments give significant relief to rosacea sufferers who experience intense neural flushing? Could it break the vicious inflammatory cycle that accompanies facial flushing?

    • Can BOTOX® treatment of rhinophyma halt the progression of this disfiguring disorder by blocking nose flushing and the resultant swelling, inflammation, and tissue growth?

    • Can BOTOX® treatment offer relief for patients who experience severe facial burning that accompanies neural-mediated flushing? Under these conditions, can treatment be covered by medical insurance?

    • Does BOTOX® treatment give clues to the underlying mechanism behind certain forms of facial flushing – allowing for the development of longer-acting topical medications?

  • #2
    Dr Nase,

    This is something we should definately ask Dr Patterson about. I know he is experiementing with botox (I had a trial with him), but I couldnt say what his results have been like across the board.

    Id be very interested to see what he'd have to say on this one.


    • #3
      I was thinking the same thing. Actually most of the BOTOX trials have been conducted in the UK. It will be interesting.