New wrinkles in use of Botox

03/29/2014 9:04 AM

08/08/2014 10:23 AM

When most people hear the term“Botox,” the first thing that usually comes to mind is wrinkle reduction.

But this Allergan-produced medication – which is a purified, pharmaceutical-level grade of a bacteria called “botulinum toxin” (the cause of, among other things, botulism) – has myriad medical applications.

Just five of them, however – for the treatment of muscle spasms around the eye; migraine headaches; severe sweating; abnormal head positioning called “cervical dystonia”; and, of course, cosmetic wrinkle removal – are U.S. Food and Drug Administration-approved.

For the numerous non-FDA-approved uses, doctors engage in a practice known as going “off label.”

This sounds far riskier than it actually is, explains Delray Beach, Fla., dermatologist Thomas Balshi.

“The term ‘off label’ sometimes has a negative connotation. But approximately 20 percent of all medications are used in an off-label way. Probably the best example of this is aspirin, which is FDA-approved for pain and fever reduction, but is used by millions ‘off label’ as a way to prevent heart attack and stroke.”

Among the conditions for which numerous specialists go off label with Botox:

• Psoriasis.
• Acne.
• Urinary incontinence.
• Jaw tightness/spasms.

In Balshi’s practice, he says he’s seen excellent results using Botox in ways that have yet to be FDA-approved. “I have successfully used Botox to treat patients with refractory psoriasis that has not responded to the standard medications.”

According to Balshi, “Botox appears to inhibit the release of chemicals from the neurotransmitters that are involved in stimulating inflammation in psoriasis.”

By blocking these inflammatory agents, Botox offers his patients some relief from the itching, burning and lesion-filled pain associated with the incurable disorder.

Another of Balshi’s preferred uses of Botox is for adult acne.

“I have found that injecting small amounts of the product just under the skin can reduce pore size, blotchiness and oily skin,” he notes.

He’s even had success treating his own painful foot condition – plantar fasciitis – with small, strategically placed injections.“They were far more effective than cortisone injections I’d received previously,” he says.

Wellington, Fla., urologist Jerry Singer is also a proponent of using Botox in certain situations. For years, he’s employed it as a treatment for urinary incontinence, overactive bladder and neurogenic bladder.

“Urinary control issues can strike otherwise healthy men and women, as well as those who suffer from neurologic conditions, such as Parkinson’s disease, multiple sclerosis or after a stroke,” Singer explains.

Singer notes that Medicare and most insurance companies will cover Botox injections when used for urinary maladies and says,“My patients like the procedure because, in addition to it having an extremely high success rate, they avoid many of the side effects associated with pills or other types of treatments.”

Of course, both Balshi and Singer point out that, in rare cases, patients can have an adverse reaction to Botox. What’s more, they stress that it’s only an acceptable treatment for these and other medical conditions when applied in the appropriate doses by a skilled, experienced physician.

Nonetheless,“I feel comfortable using Botox on my patients, especially because the amount injected is small – comparable to that of a cosmetic treatment,” Balshi says.

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