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XEOMIN in the treatment of acne, post-acne and oily seborrhea of the facial skin

The article is devoted to the use of Xeomin to reduce sebum production and pore size, as well as to correct acne and post-acne
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The relevance of the treatment of seborrheic dermatitis and acne is undeniable: these pathologies are common – in 60-80% of people aged 12-35 years, they reduce the self-esteem of patients who have difficulties in adapting in the social and intimate sphere. 30% of adolescents and 5% of adults need active psychological and psychiatric care1.

The treatment of patients with seborrhea and acne is always complex and includes pathogenetic therapy and adequate home skin care. Today, it is known that therapy with botulinum toxin type A (BTA) is an effective and safe treatment for rosacea3, seborrheic dermatitis and acne.

Sebaceous glands and oily skin
Oily skin is associated with the production of sebum by the sebaceous glands5. Hyperproduction and imbalance of secretion lipids by hyperplastic sebaceous gland is one of the main links in the pathogenesis of acne6.

The activity of the sebaceous glands is regulated mainly by hormonal mechanisms. Also, the amount and amount of sebum (sebum) produced is affected by the composition and amount of food consumed, age, gender and season 7, 9, 10. The level of sebum secretion is maximum at the age of 15 to 35 years, then it decreases. As a rule, the secretion of sebum in men is significantly higher than in women11,12.

Summarizing, we can say that all these factors can explain the variability of sebum production indicators.

Treatment methods
Most of the therapeutic approaches used to treat seborrheic dermatitis and acne have varying degrees of effectiveness and include systemic drugs such as isotretinoin, antibiotic therapy and hormonal drugs, as well as topical drugs such as external retinoids, azelaic acid, benzoyl peroxide16. In addition, photodynamic therapy and laser systems are used to treat oily skin. However, most of these methods have serious side effects, such as teratogenicity (isotretinoin), thrombophlebitis, breakthrough bleeding, nausea, breast tenderness (oral contraceptives), dryness and contact dermatitis (external retinoids, azelaic acid, benzoyl peroxide), etc. 17

Botulinum toxin
In 2002, the FDA approved botulinum toxin for use in cosmetology.

BTA has recently been used to treat rosacea, scars, acne and oily skin19. One of the first reports in the literature mentioning the potential for improving the quality of oily skin when using botulinum toxin appeared in 2008.

The mechanisms of action of botulinum toxin on oily skin
The mechanism of action of BTA, which helps to reduce the production of sebum, has not been fully established.

It is known that botulinum toxin breaks down the proteins involved in the fusion of the synoptic vesicle with the plasma membrane of the presynaptic neuron of the terminal axon. These vesicles contain the neurotransmitter acetylcholine. BTA blocks the release of this neurotransmitter into the synaptic cleft, where it usually attaches to muscarinic receptors on postsynaptic cells. The sebaceous glands contain immature and mature sebocytes expressing muscarinic acetylcholine receptors, which are important for the differentiation of sebocytes and, consequently, for the production of sebum20, 21, 22. Lee and co-authors suggested that BTA effectively reduces the production of sebum due to blockade of cholinergic synapses . The author also reports that people with oily skin are more sensitive to acetylcholine (AH) than people with normal skin, because they have more mature sebocytes and more AH. This theory was confirmed in practice, studies have shown that intradermal injections of botulinum toxin significantly reduced seborrhea in individuals with oily skin, but did not affect sebose secretion in people with normal skin15, 23.

Another version is based on the fact that most often the sebaceous gland is located between the hair follicle and the muscle that lifts the hair, the latter is stimulated by adrenaline and the sympathetic nervous system. Rose and Goldberg have suggested that intradermal injections of BTA reduce the excretion of sebum due to the neuromodulatory effect of BTA on muscle that lifts hair24.

Therefore, it can be assumed that BTA effectively reduces the production of sebum due to the blockade of cholinergic signal transmission and the neuromodulating effect of BTA on the muscle that lifts hair, but further studies are needed to understand this mechanism in more detail.

In addition, botulinum toxin also helps suppress neurogenic inflammation. BTA blocks the transport proteins involved in the release of inflammatory neurotransmitters in the terminals of sensory nerves25, 26: substance P, calcitonin-genetically bound peptide, neurokinin. Thus, we can assume the presence of anti-inflammatory action of BTA in acne.

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