title: Antibody-induced secondary treatment failure in a patient treated with botulinum toxin type A for glabellar frown lines.
abstract: Botulinum toxin type A (BTX-A) preparations are widely used nonsurgical treatments for facial wrinkles. Higher doses of BTX-A are also used for therapeutic purposes in the treatment of conditions involving increased muscle tone, such as cervical dystonia. The phenomenon of antibody-induced treatment failure is well known in the therapeutic setting, but reports are also emerging following cosmetic use of BTX-A. We describe the case of a 41-year-old female nurse who developed secondary treatment failure during 6 years of BTX-A treatment for glabellar lines. After a good response to the first BTX-A injection, the intensity and duration of effect decreased after subsequent treatments. Antibody tests revealed a high titer of neutralizing anti-BTX-A antibodies. This case shows secondary treatment failure due to the production of neutralizing antibodies following administration of BTX-A formulations for cosmetic purposes and demonstrates that immunogenicity of BTX-A preparations is an important consideration, even in the cosmetic setting.
authors.affiliation: Hautarztpraxis Stengel and Bee, Münster, Germany. praxis@stengelundbee.de
authors.forename: Gabriele
authors.initials: G
authors.lastname: Stengel
authors.forename: Eva Kristina
authors.initials: EK
authors.lastname: Bee
mesh_terms: D000328:Adult; D057134:Antibodies, Neutralizing / Q000097:blood / Q000276:immunology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000276:immunology; D005260:Female; D005546:Forehead; D006801:Humans; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000276:immunology; D015595:Skin Aging / Q000187:drug effects*; D017211:Treatment Failure
chemical_list: D057134:Antibodies, Neutralizing; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A