Antibody-induced secondary treatment failure in a patient treated with botulinum toxin type A for glabellar frown lines.

Botulinum toxin type A (BTX-A) preparations are widely used nonsurgical treatments for facial wrinkles. Higher doses of BTX-A are also used for therapeutic purposes in the treatment of conditions involving increased muscle tone, such as cervical dystonia. The phenomenon of antibody-induced treatment failure is well known in the therapeutic setting, but reports are also emerging following cosmetic use of BTX-A. We describe the case of a 41-year-old female nurse who developed secondary treatment failure during 6 years of BTX-A treatment for glabellar lines. After a good response to the first BTX-A injection, the intensity and duration of effect decreased after subsequent treatments. Antibody tests revealed a high titer of neutralizing anti-BTX-A antibodies. This case shows secondary treatment failure due to the production of neutralizing antibodies following administration of BTX-A formulations for cosmetic purposes and demonstrates that immunogenicity of BTX-A preparations is an important consideration, even in the cosmetic setting.

Treatment of extra-abdominal aggressive fibromatosis with pegylated interferon.

Aggressive fibromatosis (desmoid tumor) is a very rare neoplasm arising from the musculoaponeurotic structures. It is characterized by locally aggressive growth, and a tendency to relapse but not to metastasize. We report on a young woman with a large desmoid tumor of the left foot. Multiple operations and radiotherapy had resulted in local recurrences. Long-term immunointervention with pegylated interferon alfa-2b, however, led to marked clinical improvement of the patient's condition and a radiologically proven stabilization of the disease.