The Emerging Role of Botulinum Neurotoxin in Psoriasis Management: A Review of Mechanisms, Evidence, and Challenges

REVIEW
Ramadan S. Hussein

 
For citation: Hussein RS.The Emerging Role of Botulinum Neurotoxin in Psoriasis Management: A Review of Mechanisms, Evidence, and Challenges. International Journal of Biomedicine. 2025;15(1):51-54. doi:10.21103/Article15(1)_RA7
 
Originally published March 5, 2025

Abstract: 

Psoriasis is a chronic, immune-mediated skin condition characterized by inflammation and accelerated epidermal turnover. Current therapies, including topical and systemic agents, often face limitations such as incomplete efficacy, side effects, and patient compliance issues. Botulinum neurotoxin (BoNT), traditionally used in cosmetic dermatology and neurology, has emerged as a novel potential treatment due to its ability to modulate neuroinflammatory pathways and immune responses. This review explores the biological basis of BoNT in psoriasis, focusing on its role in inhibiting neuropeptide release, reducing pro-inflammatory cytokines, and interrupting the cycle of neuroinflammation. We examine preclinical studies and clinical trials demonstrating BoNT’s efficacy in reducing psoriasis symptoms, particularly when conventional therapies fall short.
Additionally, the review highlights the safety profile, emphasizing potential side effects such as localized muscle weakness, and discusses challenges, including standardization of dosing and long-term outcomes. Further study of BoNT's therapeutic potential, its role as an additional therapy, and the development of biomarkers for predicting patient responses are of great practical interest. In conclusion, BoNT shows promise as an innovative treatment approach for psoriasis, warranting further investigation to establish its clinical utility.

Keywords: 
Botulinum neurotoxin • psoriasis • neuroinflammation • cytokines • clinical trials
References: 
  1. Yeung H, Takeshita J, Mehta NN, Kimmel SE, Ogdie A, Margolis DJ, Shin DB, Attor R, Troxel AB, Gelfand JM. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol. 2013 Oct;149(10):1173-9. doi: 10.1001/jamadermatol.2013.5015. PMID: 23925466; PMCID: PMC3800487.
  2. McGeachy MJ, Cua DJ, Gaffen SL. The IL-17 Family of Cytokines in Health and Disease. Immunity. 2019 Apr 16;50(4):892-906. doi: 10.1016/j.immuni.2019.03.021. PMID: 30995505; PMCID: PMC6474359.
  3. Nestle FO, Di Meglio P, Qin JZ, Nickoloff BJ. Skin immune sentinels in health and disease. Nat Rev Immunol. 2009 Oct;9(10):679-91. doi: 10.1038/nri2622. Epub 2009 Sep 18. PMID: 19763149; PMCID: PMC2947825.
  4. Sandoval LF, Pierce A, Feldman SR. Systemic therapies for psoriasis: an evidence-based update. Am J Clin Dermatol. 2014 Jul;15(3):165-80. doi: 10.1007/s40257-014-0064-x. PMID: 24496885.
  5. Martina E, Diotallevi F, Radi G, Campanati A, Offidani A. Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review. Toxins (Basel). 2021 Feb 5;13(2):120. doi: 10.3390/toxins13020120. PMID: 33562846; PMCID: PMC7915854.
  6. Coetzee S, Nunez N, Belaunzaran M, Mark J, Stickler MA. Beyond Wrinkles: A Comprehensive Review of the Uses of Botulinum Toxin. J Drugs Dermatol. 2024 Mar 1;23(3):173-186. doi: 10.36849/jdd.7243e. PMID: 38443133.
  7. Aschenbeck KA, Hordinsky MK, Kennedy WR, Wendelschafer-Crabb G, Ericson ME, Kavand S, Bertin A, Dykstra DD, Panoutsopoulou IG. Neuromodulatory treatment of recalcitrant plaque psoriasis with onabotulinumtoxinA. J Am Acad Dermatol. 2018 Dec;79(6):1156-1159. doi: 10.1016/j.jaad.2018.07.058. PMID: 30420008.
  8. Popescu MN, Beiu C, Iliescu MG, Mihai MM, Popa LG, Stănescu AMA, Berteanu M. Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis. Medicina (Kaunas). 2022 Jun 16;58(6):813. doi: 10.3390/medicina58060813. PMID: 35744076; PMCID: PMC9228985.
  9. Ghaseminejad-Bandpey A, Etemadmoghadam S, Jabbari B. Botulinum Toxin Treatment of Psoriasis-A Comprehensive Review. Toxins (Basel). 2024 Oct 18;16(10):449. doi: 10.3390/toxins16100449. PMID: 39453225; PMCID: PMC11510791.
  10. Ward NL, Kavlick KD, Diaconu D, Dawes SM, Michaels KA, Gilbert E. Botulinum neurotoxin A decreases infiltrating cutaneous lymphocytes and improves acanthosis in the KC-Tie2 mouse model. J Invest Dermatol. 2012 Jul;132(7):1927-30. doi: 10.1038/jid.2012.60. Epub 2012 Mar 15. PMID: 22418873; PMCID: PMC3375348.
  11. González C, Franco M, Londoño A, Valenzuela F. Breaking paradigms in the treatment of psoriasis: Use of botulinum toxin for the treatment of plaque psoriasis. Dermatol Ther. 2020 Nov;33(6):e14319. doi: 10.1111/dth.14319. Epub 2020 Oct 8. PMID: 32949180.
  12. Amalia SN, Uchiyama A, Baral H, Inoue Y, Yamazaki S, Fujiwara C, Sekiguchi A, Yokoyama Y, Ogino S, Torii R, Hosoi M, Ishikawa O, Motegi SI. Suppression of neuropeptide by botulinum toxin improves imiquimod-induced psoriasis-like dermatitis via the regulation of neuroimmune system. J Dermatol Sci. 2021 Jan;101(1):58-68. doi: 10.1016/j.jdermsci.2020.11.003. Epub 2020 Nov 6. PMID: 33176965.
  13. Todberg T, Zachariae C, Bregnhøj A, Hedelund L, Bonefeld KK, Nielsen K, Iversen L, Skov L. The effect of botulinum neurotoxin A in patients with plaque psoriasis - an exploratory trial. J Eur Acad Dermatol Venereol. 2018 Feb;32(2):e81-e82. doi: 10.1111/jdv.14536. Epub 2017 Oct 5. PMID: 28833574.
  14. Bagherani N, Smoller BR. The efficacy of botulinum neurotoxin A in the treatment of plaque psoriasis. Dermatol Ther. 2018 Mar;31(2):e12587. doi: 10.1111/dth.12587. Epub 2018 Feb 20. PMID: 29464842.
  15. Saber M, Brassard D, Benohanian A. Inverse psoriasis and hyperhidrosis of the axillae responding to botulinum toxin type A. Arch Dermatol. 2011 May;147(5):629-30. doi: 10.1001/archdermatol.2011.111. PMID: 21576592.
  16. Gilbert E, Ward NL. Efficacy of botulinum neurotoxin type A for treating recalcitrant plaque psoriasis. J Drugs Dermatol. 2014 Nov;13(11):1407-8. PMID: 25607710.
  17. Qu HQ, Kao C, Hakonarson H. Implications of the non-neuronal cholinergic system for therapeutic interventions of inflammatory skin diseases. Exp Dermatol. 2024 Oct;33(10):e15181. doi: 10.1111/exd.15181. PMID: 39422283.

Download Article
Received December 23, 2024.
Accepted January 31, 2025.
©2025 International Medical Research and Development Corporation.