Practice Versus Protocol: A Survey of Current Botulinum Toxin Use During Lactation and Pregnancy in Dermatology

Botulinum toxin type A (BoNT-A) is widely used in dermatology, yet data on its safety during pregnancy and lactation remain limited.

To survey US dermatologists on reported practices and personal experiences with BoNT-A use during pregnancy and lactation.

A cross-sectional survey was distributed to US board-certified dermatologists through a professional networking group on a social media platform. Respondents reported whether they had administered or personally received BoNT-A during pregnancy or lactation. Participation was voluntary, and responses were deidentified prior to analysis. The survey remained open for 2 weeks and intended for exploratory analysis.

Of 177 respondents, 75% ( n = 133) reported administering or receiving botulinum toxin while breast-feeding, with no reported adverse effects. Use during pregnancy was reported by 8% in the first trimester, 5% in the second, and 7% in the third. No fetal complications were reported.

Botulinum toxin type A use during lactation was reported among many dermatologists in this survey with no reported adverse outcomes. Use during pregnancy was less frequent and approached more conservatively. These exploratory findings should be hypothesis-generating rather than evidence of safety, highlighting the gap between current self-practice and available safety data, underscoring the need for controlled studies.