Stephan Farid, Habre Maya, Tomb Roland
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
J Cosmet Dermatol. 2014 Dec;13(4):346-8. doi: 10.1111/jocd.12108.
Botulinum toxin injections have become the most frequent noninvasive cosmetic procedure carried out worldwide. Botulinum toxin has also multiple other indications in different medical fields. However, with the repetition of injections, a new concern has emerged: clinical resistance and loss of effectiveness of the treatment. After reporting a case of primary nonresponsiveness to three types of botulinum toxin type A injections, we conducted a review about all factors leading to the primary or secondary nonresponsiveness, as well as the factors affecting the immunogenicity of this neurotoxin. Most of the reports and studies focused on secondary resistance to botulinum toxin (BT) and the neurotoxin immunogenicity; primary nonresponsiveness was rarely reported. Factors leading to primary or secondary resistance to BT injections were numerous. In the majority of the studies, development of neutralizing antibodies to botulinum toxin was considered responsible of the induced clinical resistance. Patients should be aware of this rising concern as well as clinicians who should learn how to minimize the risk of resistance development, sparing the patients more invasive treatment modalities. Further studies related to botulinum toxin resistance are needed.
肉毒杆菌毒素注射已成为全球开展最为频繁的非侵入性美容手术。肉毒杆菌毒素在不同医学领域还有多种其他适应症。然而，随着注射的重复进行，一个新的问题出现了：临床耐药性和治疗效果丧失。在报告一例对三种A型肉毒杆菌毒素注射原发性无反应的病例后，我们对导致原发性或继发性无反应的所有因素以及影响这种神经毒素免疫原性的因素进行了综述。大多数报告和研究集中在肉毒杆菌毒素（BT）的继发性耐药性和神经毒素免疫原性；原发性无反应很少被报道。导致BT注射原发性或继发性耐药的因素众多。在大多数研究中，针对肉毒杆菌毒素产生中和抗体被认为是诱导临床耐药的原因。患者应了解这一日益受到关注的问题，临床医生也应学会如何将耐药性发展的风险降至最低，避免让患者接受更具侵入性的治疗方式。需要开展更多与肉毒杆菌毒素耐药性相关的研究。
