Objective: To perform a systematic review exploring the relevant literature on BoNT and BoNT-like substances in topical form and clinical trials focusing on facial muscle outcomes.

Background: Botulinum toxin (BoNT) injection is the recommended treatment for various facial conditions, such as facial wrinkles and abnormal facial movements. In most cases,  effective duration of BoNT lasts only three months, therefore, repeated injections are required if patients want to achieve sustained clinical benefits. To reduce injection discomfort and complications, several studies using a topical form of BoNT and BoNT-like substances, such as peptides, have been undertaken, mainly to reduce facial wrinkles.

Method: Systematic reviews were conducted by searching PsycINFO, Ovid MEDLINE, EMBASE, Web of Science, and Cochrane for articles published between January 1986 to February 2023 according to the PRISMA guidelines. This review focuses on topical forms of botulinum toxin and alternative substances with BoNT-like action.

Results: Of the 1176 abstracts screened, 45 articles fulfilled the selection criteria and assessed the benefit of topical BoNT and alternative substances as our primary outcome. Topical BoNT has been studied and demonstrated clinically to reduce facial wrinkles. Several substances, such as peptides and plant extracts, were used as topical BoNT-like mechanisms to reduce facial wrinkles. However, only one pilot study using a topical peptide has been conducted on facial movement disorders showing the benefit of extending the effective duration of BoNT.

Conclusion: Topical BoNT and BoNT-like substances have been studied in several trials and showed promising anti-wrinkle effects. However, evidence on facial movement disorders still needs to be obtained. The possibility of using these substances in abnormal movement conditions may be explored in future studies.

References: 1. Lungu C, Considine E, Zahir S, Ponsati B, Arrastia S, Hallett M. Pilot study of topical acetyl hexapeptide-8 in the treatment for blepharospasm in patients receiving botulinum toxin therapy. Eur J Neurol. 2013 Mar;20(3):515-518.
2. Brandt F, O’Connell C, Cazzaniga A, Waugh JM. Efficacy and safety evaluation of a novel botulinum toxin topical gel for the treatment of moderate to severe lateral canthal lines. Dermatol Surg. 2010 Dec;36 Suppl 4:2111-8.
3. Gorouhi F, Maibach HI. Role of topical peptides in preventing or treating aged skin. Int J Cosmet Sci. 2009 Oct;31(5):327-45.
4. Kanlayavattanakul, M., & Lourith, N. (2015). An update on cutaneous aging treatment using herbs. Journal of Cosmetic and Laser Therapy, 17(6), 343-352.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/topical-botulinum-toxin-like-alternatives-a-systematic-literature-review/