Botulinum toxin: a new differential diagnosis for a lytic bone lesion

Area of Science:

• Neurology
• Dermatology
• Plastic Surgery

Background:

• Botulinum toxin type A (Botox) is widely used for cosmetic and therapeutic purposes.
• It is derived from Clostridium botulinum and has various approved clinical applications.
• Its cosmetic use for facial lines is particularly prevalent.

Observation:

• A 62-year-old female developed an isolated lytic lesion on her frontal bone.
• This occurred after receiving Botulinum toxin type A injections in the frontalis muscle.
• The lesion presented as a painless forehead lump causing psychological distress.

Findings:

• Histopathology and investigation ruled out neoplastic causes for the lesion.
• The most probable cause identified was inadvertent injection of Botulinum toxin type A into the underlying frontal bone cortex.
• This represents a novel complication of Botulinum toxin type A administration.

Implications:

• This case presents a unique differential diagnosis for isolated lytic bone lesions.
• As Botulinum toxin type A use increases, clinicians should consider this potential complication.
• Awareness of this risk is crucial for patient safety in cosmetic procedures.