Immune Interactions Unique to Intradermal Microtoxin: Insights From Aesthetic, Therapeutic, and Vaccination Studies

IF 3.5 4区医学 Q2 DERMATOLOGY

Journal of Cosmetic Dermatology Pub Date : 2026-09-22 DOI:10.1111/jocd.71164

Je-Young Park, Luis Alberto Parra Hernandez, Hossam Elenany, Martina Kerscher, William Gregory Chernoff, Warner Carr, Samantha Tran

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引用次数: 0

Abstract

Introduction

Intradermal botulinum toxin type A (BoNT-A; microtoxin) has been shown to improve skin texture, superficial rhytides, and sweat/sebaceous activity through neuronal (cholinergic) and non-neuronal pathways. While discussions around immune system interactions for BoNT-A in aesthetic indications exist for intramuscular injection, the high density of antigen-presenting cells in the dermis raises the question of whether a different level of concern is warranted.

Methods

This narrative review was informed by a PubMed search through 2025 identifying studies on intradermal BoNT-A and immunogenicity using combined/related terms for BoNT-A, intradermal injection, microtoxin, immunogenicity, and skin immunology. Reference lists were screened for additional studies.

Results

The number of publications on microtoxin has increased markedly since 2024. While the skin is an immunologically active organ, immunogenicity data remain limited for aesthetic intradermal injection. To date, only a single prospective study has examined immune responses to intradermal BoNT-A in aesthetic practice. This study showed higher antibody responses with intradermal versus intramuscular delivery. Like data for intramuscular injection, there is a lack of long-term data on neutralizing antibody (NAb) development; however, in the context of increasing BoNT-A doses for facial treatment and increasing long-term exposure, introduction of BoNT-A into the dermis over a large surface may raise the risk of NAb development.

Conclusions

Microtoxin techniques may heighten immunogenic potential through dermal antigen exposure and frequent retreatment. IncobotulinumtoxinA is free of complexing proteins and has a low antigenic protein burden, which may favor its use for intradermal injection. However, direct long-term comparative evidence for aesthetic intradermal treatments is lacking.

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皮内微毒素特有的免疫相互作用：来自美学、治疗和疫苗研究的见解

皮内肉毒毒素A型（BoNT-A；微毒素）已被证明可以通过神经元（胆碱能）和非神经元途径改善皮肤质地、浅表节律和汗液/皮脂腺活动。虽然关于肌肉注射BoNT-A在美学适应症中免疫系统相互作用的讨论存在，但真皮中抗原呈递细胞的高密度提出了是否需要不同程度关注的问题。方法：本综述通过PubMed检索到2025年皮内BoNT-A和免疫原性的研究，使用BoNT-A、皮内注射、微毒素、免疫原性和皮肤免疫学的组合/相关术语。筛选参考文献清单以供进一步研究。结果自2024年以来，微毒素相关文献数量显著增加。虽然皮肤是一个具有免疫活性的器官，但用于美容皮内注射的免疫原性数据仍然有限。迄今为止，只有一项前瞻性研究检查了美学实践中皮内BoNT-A的免疫反应。这项研究显示皮内给药比肌肉给药有更高的抗体反应。与肌内注射的数据一样，缺乏中和抗体（NAb）发展的长期数据；然而，在面部治疗中BoNT-A剂量增加和长期暴露增加的背景下，将BoNT-A大面积引入真皮层可能会增加NAb发展的风险。结论微毒素技术可通过皮肤抗原暴露和频繁的再治疗提高免疫原性。incoboulinumtoxina不含络合蛋白，抗原蛋白含量低，这有利于皮内注射。然而，美容皮内治疗的直接长期比较证据是缺乏的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cosmetic Dermatology DERMATOLOGY-

CiteScore

4.30

自引率

13.00%

发文量

818

审稿时长

>12 weeks

期刊介绍： The Journal of Cosmetic Dermatology publishes high quality, peer-reviewed articles on all aspects of cosmetic dermatology with the aim to foster the highest standards of patient care in cosmetic dermatology. Published quarterly, the Journal of Cosmetic Dermatology facilitates continuing professional development and provides a forum for the exchange of scientific research and innovative techniques. The scope of coverage includes, but will not be limited to: healthy skin; skin maintenance; ageing skin; photodamage and photoprotection; rejuvenation; biochemistry, endocrinology and neuroimmunology of healthy skin; imaging; skin measurement; quality of life; skin types; sensitive skin; rosacea and acne; sebum; sweat; fat; phlebology; hair conservation, restoration and removal; nails and nail surgery; pigment; psychological and medicolegal issues; retinoids; cosmetic chemistry; dermopharmacy; cosmeceuticals; toiletries; striae; cellulite; cosmetic dermatological surgery; blepharoplasty; liposuction; surgical complications; botulinum; fillers, peels and dermabrasion; local and tumescent anaesthesia; electrosurgery; lasers, including laser physics, laser research and safety, vascular lasers, pigment lasers, hair removal lasers, tattoo removal lasers, resurfacing lasers, dermal remodelling lasers and laser complications.