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Facial Blanching Due to Neurotoxins: Proposed Mechanisms.
MedLine Citation:
PMID:  23252719     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The effect of perceived facial blanching with neurotoxin therapy has been described in the literature and has been used to treat the undesirable facial flushing of Frey's syndrome. Patients rarely report it as a complication after cosmetic injection, but it can be distressing. OBJECTIVES: To elucidate the proposed mechanism(s) of this unusual vasculocutaneous phenomenon, we reviewed normal physiologic responses to heat stress and the role of cholinergic neurotransmission in modulating cutaneous vascular tone in the context of the literature. MATERIALS/METHODS: We report a case of a 32-year-old woman who complained of white patches on her forehead at sites of abobotulinumtoxinA injections administered 2 weeks before presentation. RESULTS: Acetylcholine is a primary mediator of cutaneous vasodilatation; certain co-transmitters modulate its effect. Chemical denervation by botulinum toxin (BoNT) appears to interfere with these normal signaling pathways and can provide symptomatic relief to patients with undesirable facial flushing. Conversely, it may create an unwanted cosmetic effect in patients who desire isolated muscle paresis. CONCLUSIONS: Skin sites injected with BoNT type A may not experience the expected decrease in cutaneous vessel tone associated with higher body temperature. The exact mechanism remains unclear.
Authors:
Tanya T Khan; Kathleen Herne; Steven H Dayan; Julie A Woodward
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-17
Journal Detail:
Title:  Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]     Volume:  -     ISSN:  1524-4725     ISO Abbreviation:  Dermatol Surg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504371     Medline TA:  Dermatol Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
Affiliation:
Department of Ophthalmology, Health Sciences Center, Louisiana State University, New Orleans, Louisiana; Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, Louisiana.
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