title: Antibody-induced failure of botulinum toxin type A therapy in a patient with masseteric hypertrophy.
abstract: BACKGROUND
  With the expanding use of botulinum toxin, much concern about the antibody against botulinum toxin is arising. Unlike neurologic indications such as cervical dystonia, antibody-induced failure of botulinum toxin therapy has never been reported in the cosmetic field.
  
  
  OBJECTIVE
  The objective was to describe a case of an antibody-induced failure of botulinum toxin type A (BTX-A) therapy (BOTOX, Allergan, Inc.) that occurred in a patient with masseteric hypertrophy.
  
  
  METHODS
  We present a 20-year-old girl who developed antibody-induced therapy failure after the fourth injection series. Sixty units of toxin was injected at each series and the intertreatment interval was four to five months.
  
  
  RESULTS
  Frontalis test revealed no paresis of muscle after a unilateral injection of BTX-A. Circulating antibodies against BTX-A were detected by indirect enzyme-linked immunosorbent assay and mouse protection assay.
  
  
  CONCLUSIONS
  This case is unique in that, first, immunoresistance developed in a patient of cosmetic indication where only a small dose of BTX-A was administered and, second, antibodies developed on the so-called new formulation of BOTOX. Our case alerts cosmetic surgeons to the importance of antibody against the botulinum toxin.
authors.affiliation: Mein Skin Clinic, 1306-1 Seocho-4-dong, Seocho-ku, Seoul 137-855, South Korea. derma@unitel.co.kr
authors.forename: Soo-Keun
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D000917:Antibody Formation / Q000276:immunology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008406:Masseter Muscle / Q000473:pathology*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*
chemical_list: D000906:Antibodies; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A