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Botulinum toxin safety — SCE Dermatology MCQ

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HardSkin surgery and cosmetic dermatologyBotulinum toxin safetySCE Dermatology

A 44-year-old woman requests botulinum toxin injections for glabellar lines. She reports fluctuating ptosis and fatigable diplopia under neurological investigation, with suspected myasthenia gravis. She is otherwise well and has no active skin infection. What is the most appropriate decision. What is the most appropriate treatment?

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Correct answer: E — Defer botulinum toxin pending neurological diagnosis

The correct answer is E, defer botulinum toxin pending neurological diagnosis. The stem describes fluctuating ptosis and fatigable diplopia with suspected myasthenia gravis, a disorder of neuromuscular junction transmission. Botulinum toxin works by blocking acetylcholine release at the presynaptic neuromuscular junction, the same site targeted by myasthenic pathology, so administering it in a patient with unconfirmed or active neuromuscular junction disease risks precipitating severe, potentially life-threatening generalised weakness or respiratory compromise. Manufacturer product information explicitly lists neuromuscular junction disorders such as myasthenia gravis as a caution requiring specialist risk assessment before treatment. Until the neurological workup excludes or confirms and stabilises the diagnosis, cosmetic injection cannot be considered safe, so deferral is the only responsible course.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions