Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review

Toxins (Basel). 2021 Feb 5;13(2):120. doi: 10.3390/toxins13020120.


Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey-Hailey disease, epidermolysis bullosa simplex Weber-Cockayne type, Darier's disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

Keywords: Darier’s disease; Hailey–Hailey disease; Raynaud phenomenon; alopecia; aquagenic keratoderma; botulinum toxin; dermatology; epidermolysis bullosa simplex Weber–Cockayne type; facial erythema and flushing; focal idiopathic hyperhidrosis; notalgia paresthetica; oily skin; pachyonychia congenita; psoriasis; skin diseases; suppurative hidradenitis.

Publication types

  • Systematic Review

MeSH terms

  • Botulinum Toxins / administration & dosage*
  • Botulinum Toxins / adverse effects
  • Dermatologic Agents / administration & dosage*
  • Dermatologic Agents / adverse effects
  • Dermatology*
  • Female
  • Humans
  • Male
  • Off-Label Use
  • Patient Safety
  • Risk Assessment
  • Risk Factors
  • Skin Diseases / drug therapy*
  • Treatment Outcome


  • Dermatologic Agents
  • Botulinum Toxins