Breaking News
April 20, 2018 - FDA Alert: Certain Kratom-Containing Powder Products by Viable Solutions: Recall -Possible Salmonella Contamination
April 20, 2018 - What is heart failure?
April 20, 2018 - Inactivity of astronauts during spaceflights may have more pronounced effect on skeletal muscle than hypoxia
April 20, 2018 - New SIDS Info app seeks to reduce infant sleep-related deaths
April 20, 2018 - Wide-scale distribution of naloxone effectively prevents overdose deaths, study finds
April 20, 2018 - Triple-negative breast cancer found to be chemoresistant prior to treatment
April 20, 2018 - ACL tears occur the same way in women and men, study finds
April 20, 2018 - UT Southwestern researchers identify 170 potential therapeutic targets for lung cancer
April 20, 2018 - Finding the ‘keyhole’ to beat obesity at the cellular level
April 20, 2018 - Long-term exposure to cold temperatures reduces diabetes and obesity, shows study
April 20, 2018 - Metabolic Syndrome Common With Chronic Hep B Infection
April 20, 2018 - Tracking quality of life during prostate cancer treatment
April 20, 2018 - Study shows presence of beta-amyloid dimers in the brains of Alzheimer’s patients
April 20, 2018 - Researchers identify link between physical inactivity and increased risk of dying from cancer
April 20, 2018 - Breathtaking evolution amongst Indonesian tribe
April 20, 2018 - Study shows testosterone deficiency in men is associated with chronic diseases
April 20, 2018 - Simple one-page form helps improve satisfaction of patients with care
April 20, 2018 - Researchers evaluate accuracy of simple blood test to predict lung cancer
April 20, 2018 - Study looks at sperm producing ability in testicular cancer patients
April 20, 2018 - Exercise In, Vitamin D Out for Preventing Falls: U.S. Panel
April 20, 2018 - Skin cancers associated with decreased risk of developing AD
April 20, 2018 - Preserving fertility during chemotherapy
April 20, 2018 - Teva and Procter & Gamble Company terminate PGT Healthcare partnership
April 20, 2018 - People diagnosed with traumatic brain injury may have increased risk of Parkinson’s disease, shows study
April 20, 2018 - Researchers use smartphone to diagnose people infected with Loa loa worm
April 20, 2018 - College students with autism have high rate of suicidal thoughts
April 20, 2018 - Study sheds light on how the HSC niche is maintained
April 20, 2018 - Drug test spurs frank talk between hypertension patients and doctors
April 19, 2018 - Low-cost deworming drug improves female farmers’ physical fitness
April 19, 2018 - Genome editing identifies neural circuit behind leptin’s anti-obesity and anti-diabetes effects
April 19, 2018 - Many European countries lack comprehensive policy to eliminate viral hepatitis
April 19, 2018 - Young people with ADHD ‘more likely’ to come from deprived neighbourhoods
April 19, 2018 - SLU professor discovers new biomarkers for chlorine gas exposure
April 19, 2018 - Study proposes new mechanism that may contribute to gender differences in weight control
April 19, 2018 - Sleep restriction therapy does not interfere with insomnia patient’s driving ability, research shows
April 19, 2018 - Deep brain stimulation offers relief to UTHealth patient with treatment-resistant depression
April 19, 2018 - Study shows fatty fish and camelina oil boost HDL and IDL cholesterol
April 19, 2018 - FDA Alert: Euphoric Capsules by Epic Products: Recall
April 19, 2018 - Researchers identify peptide produced during cartilage deterioration as a potential source of osteoarthritis pain
April 19, 2018 - New breakthrough may allow scientists to orchestrate tissue regeneration in humans
April 19, 2018 - SYGNIS AG introduces new TruePrime apoptotic cell free DNA amplification kit
April 19, 2018 - Innovative device shows promise in capturing and releasing circulating tumor cells
April 19, 2018 - Researchers shed light on role of striosomal neurons in reinforcement learning
April 19, 2018 - Genetic make-up impacts long-term effectiveness of phobia treatment
April 19, 2018 - Novel biomarker can distinguish malignant lung nodules
April 19, 2018 - Study reports promising novel approach to treat therapy resistant pediatric brain tumors
April 19, 2018 - One-Hour Plasma Glucose Useful Predictor of Diabetic Retinopathy
April 19, 2018 - Hydroxychloroquine no more effective than placebo for relieving osteoarthritis hand pain
April 19, 2018 - Transplanted livers have a protective effect and reduce potential for organ rejection
April 19, 2018 - Researchers develop new method to study activity of inflammatory cells
April 19, 2018 - Researchers discover highly antibiotic resistant superbugs in Gulf States
April 19, 2018 - Smart-tooth technology shows promise in detecting certain diseases in high-risk patients
April 19, 2018 - Interaction between dioxin and HLA gene variant activates events associated with rheumatoid arthritis
April 19, 2018 - Eyes of adolescents could be associated with increased risk of cardiovascular disease in later life
April 19, 2018 - U.S. Women Less Likely Than Men to Get Statins After Heart Attack
April 19, 2018 - Health Canada grants cannabis cultivation license to High Park Farms
April 19, 2018 - Atypical brain development observed in preschoolers with ADHD symptoms
April 19, 2018 - SC Johnson releases annual Sustainability Report
April 19, 2018 - Positive attitudes about aging reduce risk of dementia in older adults
April 19, 2018 - Environmental pollutants found to worsen rheumatoid arthritis
April 19, 2018 - UT Southwestern scientists discover protein linked to metastatic breast cancer
April 19, 2018 - Study highlights need for further evidence to improve symptom management in end of life care
April 19, 2018 - Detecting diminished dopamine-firing cells inside brain could reveal earliest signs of Alzheimer’s
April 19, 2018 - Uniqsis offers high-power LED light unit for scalable flow photochemistry reactions
April 19, 2018 - Case study shows how intravascular ultrasound imaging helps detect acute aortic syndrome
April 19, 2018 - Research reveals new mechanism by which HIV evades the immune system
April 19, 2018 - Nanodisc-delivered cancer treatment helps eliminate tumors
April 19, 2018 - Functional connectivity MRI could help detect brain disorders and diseases
April 19, 2018 - Finding better way to quantify neuropathy symptoms and treatment efficacy
April 19, 2018 - Study examines effectiveness of caregiver education about sickle cell trait
April 19, 2018 - High-resolution images of tumor vasculature using new technology
April 19, 2018 - Lack of sleep may be linked to risk factor for Alzheimer’s disease
April 19, 2018 - Study finds neurotransmitter may play a role in alcohol relapse, addiction
April 19, 2018 - Researchers build molecular networks of calcific aortic valve disease
April 19, 2018 - Researchers develop highly specific apoptosis assay for pharmacodynamic analyses of tumor specimens
April 19, 2018 - Scientists decipher mechanism of chemotherapy induced female infertility
April 19, 2018 - New insight may allow researchers to design drugs that improve immune responses to vaccines
April 19, 2018 - FDA Approves Crysvita (burosumab-twza) for X-Linked Hypophosphatemia
April 19, 2018 - Researchers uncover origin of virus-fighting plasma B cells
April 19, 2018 - Study finds no evidence of lower intelligence in young children who had anesthesia
Facial Scarring Improved with Botulinum Toxin

Facial Scarring Improved with Botulinum Toxin

image_pdfDownload PDFimage_print

Action Points

  • Note that this small randomized trial suggested that botulinum toxin may be superior to placebo for reducing certain scar characteristics after a laceration closure.
  • Be aware that the primary outcome, score on the Vancouver Scar Scale, was not significantly different between the two groups, but this may be due to the small sample size for comparison.

Intradermal injection of botulinum toxin type A (Botox) immediately following wound closure improved the appearance of facial surgical scars compared with control scars in a small, randomized, double-blind trial from the People’s Republic of China.

At 6 months’ follow-up, the half of each facial scar treated with the injections following wound closure was narrower and flatter than the half left untreated, Li Hu, MD, PhD, and colleagues from the Shanghai Jiao Tong University School of Medicine Shanghai, reported in Plastic and Reconstructive Surgery.

The mean Vancouver Scar Scale score, used to characterize hypertrophic scars, was also lower for the half of the scar that was treated with the toxin, at 4.68 compared with 5.24 for the half that was not treated, although this difference was not statistically significant (P=0.146), the investigators added.

“Too many reports have focused on the treatment rather than the prevention of untoward surgical scars. However, early management of surgical scars is more likely to yield a better cosmetic appearance and require fewer treatments. This study demonstrates that early postsurgical botulinum toxin injections can produce better, narrower, and flatter facial surgical scars [than scars that remain untreated].”

For the study, 16 patients were randomized to receive botulinum toxin type A injections to half of their facial scar and the other half of the scar was treated with 0.9% normal saline.

“Immediately after skin closure, the encoded vial contents (0.2 mL containing 10 U for each 1-cm scar) were injected at a distance of 5 mm on either side of the wound,” the team wrote. The mean amount of botulinum toxin injected per scar was 33.7 U (range, 15 to 80 U). The mean age of the subjects was 12 (range, 6 to 49), while the mean length of the scar was 6.74 cm (range, 3 to 16 cm). The original diagnoses included congenital melanocytic nevi, port-wine stains, arteriovenous malformations, and disfiguring scars. Fourteen of the 16 patients completed the study.

In a subset analysis, the difference in the Vancouver Scar Scale height score at 6 months was significantly lower, at 0.47 for the treated part of the scar compared with 0.76 for the half that was not treated (P=0.009). At the same time point, the treated portion of the scar was also significantly narrower at 0.32, compared with 0.43 (P=0.001) for the untreated segment of the scar. The mean visual analogue scale (VAS) score was also higher at 5.76 for the treated part of the scar, compared with 4.97 for the control side — a difference between the two sides that was again significant (P=0.046).

In contrast, no significant differences were seen in the subdomains of pigmentation at 1.63 for the treated side versus 1.58 for the control side (P=0.391) or in vascularity, at 1.24 for the treated side versus 1.32 for the control side (P=0.263). No adverse events were noted. Tension at the edges of a wound significantly contributes to unsightly scars, the researchers explained.

“Temporary muscular paralysis induced by botulinum toxin type A could decrease movement and stress around a healing wound. This relief of tension may help prevent facial scar widening, hypertrophy, and hyperpigmentation.”

The authors also noted that botulinum toxin may have a direct inhibitory effect on fibroblasts and transforming growth factor-β1 expression, both key to the development of hypertrophic scars. A previously published study similarly found that early injections of the same botulinum toxin improved the appearance of facial scars — again by inducing temporary muscle paralysis and decreasing tension on wound edges.

Asked for her opinion, Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C., who was not involved with the study, pointed out that one of the limitations was the small sample size. She also noted that in general, scars on the face and neck tend to heal fairly well, as they are not under a lot of tension, which can contribute to unsightly scars.

However, she said she agreed in principle that starting early to try and minimize scars is a good idea: “I do a lot of laser scar revision and even using lasers to reverse red or hypertrophic keloid scars, we found that the earlier you start using the laser, the less severe the scar, and the earlier the scar looks better.”

In addition, Alster said, for many practitioners, incorporating the use of botulinum toxin into the practice of scar management is likely to be more readily available than the use of lasers, although in her own practice, she has found it actually to be less expensive and even less invasive to use a laser for scar revision than to inject botulinum toxin around a wound.

“I think it’s an important study if only because it asks the question, will the use of Botox or any of the other neuromodulators reduce scar formation by directly reducing the mechanical forces across a wound bed, and that answer is likely yes.”

“So in general this is a ‘thumbs up’ study, but with the caveat that larger studies of more significant scars are still warranted.”

The study authors, as well as Alster, reported having no financial conflicts of interest.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-03-13T12:00:00-0400

Tagged with:

About author

Related Articles