Neutralizing antibodies to botulinum neurotoxin type A in aesthetic medicine: five case reports
Case 2 concerns a 54-year-old Caucasian woman who had been receiving botulinum toxin type A preparations for 2 years. She was initially treated with abobotulinumtoxinA (Dysport®) in April 2009, when she received 50 Speywood U over five injection points in the glabella, 20 U over ten injection points in the frontalis muscle, 50 U (25 each side) over four injection points in the orbicularis oculi, and 50 U in the jawline, along and below the mandibular line (). Within the next 4 weeks, she received 50 U over ten injection points in the platysmal bands with two further top-ups in the platysmal bands over the following month (). Over the course of the year, the woman received three more treatments with abobotulinumtoxinA (Dysport®) in the glabella, frontalis, orbicularis oculi, and jawline as outlined in .\nIn May 2010, the woman received further injections with abobotulinumtoxinA (Dysport®) in the glabella, frontalis, orbicularis oculi, and platysmal bands (), but reported that the treatment was not working as well as it had been ( and ). At the next treatment, 6 months later, she was switched to onabotulinumtoxinA (BOTOX®) (), but the treatment had little effect. Three months later, the patient returned to treatment with abobotulinumtoxinA (Dysport®), but reported no effect after 4 weeks. A final treatment with incobotulinumtoxinA (Xeomin®/Bocouture®; Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany) was tried 9 months later, but the duration of effect was only 2 weeks. The patient tested positive (++) for antibodies to botulinum toxin type A. At this time, no further therapy is planned.