Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Toxins (Basel). 2021 Nov 19;13(11):817. doi: 10.3390/toxins13110817.


Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.

Keywords: acetylcholine; acne vulgaris; botulinum toxins; cholinergic receptors; non-neuronal cholinergic system; oily skin; sebaceous glands; seborrhea; sebum.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acetylcholine / metabolism
  • Acetylcholine Release Inhibitors / administration & dosage
  • Acetylcholine Release Inhibitors / pharmacology
  • Acne Vulgaris / drug therapy*
  • Acne Vulgaris / pathology
  • Animals
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / pharmacology
  • Dermatitis, Seborrheic / drug therapy*
  • Dermatitis, Seborrheic / pathology
  • Humans
  • Sebaceous Glands / drug effects
  • Sebum / metabolism


  • Acetylcholine Release Inhibitors
  • Botulinum Toxins, Type A
  • Acetylcholine