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Skin reactions after intramuscular injection of Botulinum toxin A: A rare side effect
  1. N Brueggemann1,
  2. L Doegnitz2,
  3. L Harms3,
  4. A Moser1,
  5. J M Hagenah1
  1. 1
    Department of Neurology, University of Luebeck, Luebeck, Germany
  2. 2
    Department of Neurology, Jewish Hospital Berlin, Berlin, Germany
  3. 3
    Department of Neurology, Charité Hospital, Humboldt University, Berlin, Germany
  1. Dr Johann Hagenah, Department of Neurology, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; johann.hagenah{at}

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The use of Botulinum toxin (BTX) has been constantly increasing over the past years, not least on account of obtaining the license for the treatment of facial lines. It has proven a safe drug with only a few adverse effects. Local irritations at the injection site are not uncommon, whereas more widespread and generalised exanthemas were first described in 1992.1 One dramatic case documents a lethal outcome due to treatment with a mixture of BOTOX® (BTX-A) and lidocaine.2 In accordance with databases from the companies Allergan and Ipsen (SPC BOTOX®, Allergan, December 2005; SPC, DYSPORT®, Ipsen Pharma, April 2006), skin reactions seem to be a rare phenomenon with a frequency of less than 1:1,000. The Ipsen database (January 2007) mentions 5 cases of local and 4 cases of more widespread redness, bulging and pruritus in Germany, as well as 11 cases abroad. Here, we report on two further cases of rapid-onset skin reactions after injection of two different BTX-A products.


A 49-year-old woman developed a left-sided spastic hemiparesis after cavernoma exstirpation in 1997. Successful treatment of the spastic arm muscles was carried out with BOTOX® for about 5 years and with DYSPORT® for the last 4 years. She did not receive …

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  • Competing interests: None.