Vasculitis beyond the areas of Botulinum toxin‐A injection, increasing concerns?

BACKGROUND: Botulinum toxins-A, as the most common non-surgical method for facial rejuvenation, have been used broadly. OBJECTIVE: Despite its significant aesthetic aspects, particular undesirable adverse effects could occur. AIM: The aim of this case report is to present the most serious side effects of botulinum toxin injections. PATIENTS/METHODS: A case report of a middle age woman with side effects of botulinum toxin injection with presentation of erythema and edema on the sites of injection and more further on the face and neck. The skin biopsies from both sides were obtained. On the skin biopsy the small vessel vasculitis on the site on injection and more further on the face and neck was performed as a result of injections. RESULTS: Following Botulinum toxin-A injection, various cutaneous reactions could occur. Some of these reactions such as edema and erythema may be self-limited and has not serious impact on patients life but also some severe reactions like this case may occur which may alarm the life threatening side effects of injections. These reactions may be due to molecular patterns and exogenous proteins that have the potential for activating the immune cascade. CONCLUSION: Using the unapproved Botulinum toxin-A should be discouraged due to their hazard of systemic reactions and clinicians should avoid administering the unlicensed products even by patients request or lack of the allergic reactions from previous injections.