Hexsel Doris, Valente-Bezerra Indira, Mosena Gabriela, Oakim Mourao Maria Antonia, Fabris Vitor Costa
Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil.
Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil.
Dermatol Pract Concept. 2023 Jul 1;13(3):e2023168. doi: 10.5826/dpc.1303a168.
Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles.
To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements.
Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment.
Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%).
The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.
研究表明，A型肉毒毒素可能改善皮肤质量，且已对使用超稀释剂量肉毒毒素（微剂量注射）的应用方案进行了研究，以此作为在不完全麻痹目标肌肉的情况下实现治疗目标的一种方法。
通过客观和主观测量来评估联合应用标准剂量和微剂量阿柏西普肉毒毒素A改善皮肤质量的效果。
30例患者接受了肉毒毒素治疗，采用标准技术和微剂量注射技术。对治疗区域的效果进行客观（皮脂测量仪、皮肤色素仪和数字皮肤镜图像）和主观（整体美学改善量表和面部皮肤质量临床评估量表）测量，以评估治疗效果。
数字皮肤镜显示红斑和毛细血管扩张明显减少。红斑和毛细血管扩张在客观和主观测量中均有所改善。皮脂分泌、静态皱纹、丘疹和脓疱以及毛孔粗大在主观测量中有所改善。尽管不良事件发生率较高（56%），但患者满意度较高（93%）。
联合应用标准剂量和微剂量阿柏西普肉毒毒素A可有效改善面部皮肤的整体质量。对红斑和毛细血管扩张的作用表明，它是治疗红斑毛细血管扩张型玫瑰痤疮患者的有效治疗选择。在下半脸和中脸应用微剂量肉毒毒素时，应根据每位患者的情况定制注射剂量和模式，以减少不良事件的发生。
