Clinical characteristics and therapy experience of 179 cases of botulism induced by cosmetic botulinum toxin injections
10.3760/cma.j.cn114453-20250314-00065
- VernacularTitle:179例美容注射肉毒毒素中毒的临床特点及治疗经验
- Author:
Yangyang XU
1
;
Xin LYU
1
;
Xiangyu JI
1
;
Yue WANG
1
;
Lipeng ZHU
1
;
Hongwei CAO
1
Author Information
1. 郑州大学第五附属医院医疗美容整形外科，郑州 450001
- Publication Type:Journal Article
- Keywords:
Botulinum toxins;
Botulism;
Cosmetic injections;
Botulinum antitoxin;
Desensitization therapy
- From:
Chinese Journal of Plastic Surgery
2025;41(10):1023-1031
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical characteristics and treatment experience of patients with botulism after cosmetic botulinum toxin injection.Methods:A retrospective study was conducted on patients admitted to the Department of Medical Aesthetic and Plastic Surgery of the Fifth Affiliated Hospital of Zhengzhou University for botulism after cosmetic botulinum toxin injection between January 1, 2023, and October 31, 2024. Clinical data and treatment regimens were collected. Patients received botulinum antitoxin injection, neurotrophic therapy, nutrition supplementation, modulation and enhancement of cellular immune function, and systemic supportive care based on their condition. Prior to antitoxin administration, a skin test was performed. Patients with a negative test received intramuscular injections of 10 000 U of antitoxin serum every 12 hours, while those with a positive result underwent a desensitization protocol. The cessation criterion was significant improvement of toxic symptoms. Data collected included age, gender, region, time of presentation, injection location, brand and type of toxin, injection time, sites and dose of injection, time to onset of initial symptoms, main symptoms, skin test result for antitoxin, dosage of antitoxin administered, length of hospital stay, adverse reactions and prognosis. Data analysis was performed using GraphPad Prism Version 10.2.0.Results:A total of 179 patients were included, with 8 cases in 2023 and 171 cases in 2024. The majority were female (97.2%, 174 cases). The age range was 18-62 years, with a median age of 35 years; the highest proportion was in the 20-40 age group (71.5%, 128 cases). Patients were from 23 different provinces, autonomous regions, and municipalities directly under the central government in China. The injected product was mostly an unspecified brand of botulinum toxin (57.5%, 103 cases). Injections were primarily administered in non-medical institutions, with beauty salons or private studios accounting for 88.8% (159 cases). Injection sites included the platysma (92 cases), masseter muscle (82 cases), orbicularis oculi muscle (82 cases), frontalis muscle (67 cases), among others, with some patients receiving injections at multiple sites. 69 cases (38.5%) of patients were unaware of the injected dose; for the remaining cases, based on information provided, the injected doses were all within the safe range. The incubation period was mostly 1-7 days. The main symptoms included fatigue (171 cases), dysphagia (137 cases), dizziness (101 cases), blurred vision (76 cases), and difficulty opening eyes (66 cases). 176 patients received botulinum antitoxin treatment; 82 cases (46.6%) had a positive skin test and received desensitization injections, while 94 cases (53.4%) had a negative test. The total dosage of antitoxin used ranged from 10 000 U to 240 000 U. Three patients received only adjuvant therapy such as neurotrophic support. Adverse reactions during treatment primarily included induration at the injection site and serum sickness, all of which resolved after symptomatic treatment with antihistamines, steroids, etc. The hospital stay ranged from 1 to 24 d, with an average of 4.6 d. Upon discharge, symptoms in all patients had alleviated or resolved. At the 6-month follow-up after discharge, 14 patients were lost to follow-up; the remaining patients recovered well with no other complications.Conclusion:Poisoning incidents due to the illegal or improper use of botulinum toxin are increasing. Administration of botulinum antitoxin is an effective means to ameliorate intoxicating symptoms. Patients should seek timely medical intervention and receive antitoxin treatment as early as possible. Desensitization administration does not affect the efficacy of the antitoxin.
