Botulinum Toxin

Pathologic scars remain a therapeutic enigma. Several therapeutic modalities have been described for the prevention and treatment of hypertrophic and keloid scars, but the optimal management approach has not yet been defined. This article reviews the newly emerging, off-label treatment, botulinum toxin-A (BTXA) for scar reduction. Eight in vitro, 9 in vivo animal, and 23 human clinical studies were deemed relevant to this review. Studies were conducted between 2000 and 2018. Clinical studies were of various methodologic qualities and comprised of 8 blinded randomized control trials, 7 cohort studies, and 7 case series/reports. Across all 23 human clinical studies, 521 patients were recruited, 20 studies were in favor of BTXA to reduce scars, 2 studies had equivocal results, and 1 study showed no benefit. The efficacy of BTXA to reduce scars appears promising and the clinical literature currently favors its use over placebo controls as a safe scar reduction alternative. The efficacy of this modality in comparison with other more widely accepted scar reduction methods is less clear. Further understanding of the molecular mechanism of action of BTXA upon scars and treatment modality cost-effectiveness comparisons remain to be explored. Large-scale randomized control trials of high methodologic quality, using objective measurement scales, must be produced to truly determine the efficacy of this innovative treatment