Said Samireh, Meshkinpour Azin, Carruthers Alastair, Carruthers Jean
University of California, Irvine, California, USA.
Am J Clin Dermatol. 2003;4(9):609-16. doi: 10.2165/00128071-200304090-00003.
The use of botulinum toxin A in cosmetic dermatology has increased in popularity due to the efficacy and relative safety of the treatment. Botulinum toxin A is one of eight exotoxins produced by Clostridium botulinum, a Gram-positive, spore-forming anaerobe. Flaccid paralysis results from the denervation of muscle fibers at the neuromuscular junction after botulinum toxin A administration. While treating blepharospasm, the Carruthers incidentally found that botulinum toxin A improved glabellar frown lines. Dynamic rhytides occur in areas of dynamic motion. These types of lines may be improved with botulinum toxin A. There are two types of botulinum toxin A commercially available (BOTOX and Dysport); only BOTOX is currently available in the US. The efficacy and tolerability of BOTOX was best demonstrated with a multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines in 264 patients. There was a significantly greater reduction in glabellar line severity with BOTOX. The effect was maintained for the duration of the study (120 days). There was low occurrence (5.4%) of mostly mild blepharoptosis in the BOTOX group. In another prospective study, it was found that about 1% of BOTOX patients reported severe headache. Botulinum toxin A can provide an alternative treatment of palmar and axillary hyperhidrosis when options such as topical agents (aluminum chloride) and iontophoresis have failed.
由于肉毒杆菌毒素A治疗的有效性和相对安全性，其在美容皮肤科的应用越来越受欢迎。肉毒杆菌毒素A是由肉毒杆菌产生的八种外毒素之一，肉毒杆菌是一种革兰氏阳性、形成芽孢的厌氧菌。注射肉毒杆菌毒素A后，神经肌肉接头处的肌纤维去神经支配会导致弛缓性麻痹。在治疗眼睑痉挛时，卡拉瑟斯偶然发现肉毒杆菌毒素A改善了眉间皱纹。动态皱纹出现在动态运动的区域。这类皱纹可用肉毒杆菌毒素A改善。市面上有两种肉毒杆菌毒素A（保妥适和衡力）；目前在美国只有保妥适可用。一项针对264例患者进行的关于A型肉毒杆菌毒素治疗眉间纹疗效和安全性的多中心、双盲、随机、安慰剂对照研究，最能证明保妥适的疗效和耐受性。使用保妥适后，眉间纹严重程度的降低更为显著。这种效果在研究期间（120天）得以维持。保妥适组中主要为轻度上睑下垂的发生率较低（5.4%）。在另一项前瞻性研究中，发现约1%的保妥适治疗患者报告有严重头痛。当外用药物（氯化铝）和离子电渗疗法等治疗方法无效时，肉毒杆菌毒素A可提供一种治疗手掌和腋窝多汗症的替代方法。
