Empirical reports on the use of BoNTA to suppress excessive sebum suggest that BoNTA could modulate the neuroendocrine control over the SGs. The neuronal control over the SG has long been implicated by clinical observations. Another well-known cutaneous exocrine gland is the SG, opening into a hair follicle to secrete sebum. The ability of BoNTA to inhibit cholinergic transmission prompted further investigations into its clinical use in several autonomic disorders resulting in glandular hypersecretion, such as hyperhidrosis and sialorrhea.
Acting at the neuromuscular junction, BoNTA leads to a loss of muscle tone, while in some glandular tissues, it inhibits cholinergic sympathetic nerve function. Note the lobules of mature sebaceous glands and a dilated follicular infundibulum filled with keratinous material (nose, hematoxylin, and eosin staining, ×50).īotulinum neurotoxin type A (BoNTA) blocks the release of acetylcholine (Ach) into the synaptic cleft, where it binds to a cholinergic receptor on a post-synaptic cell. ( a) A young Korean male with facial seborrhea appearing greasy and shiny, accompanied by enlarged pores on the cheeks ( b) Histologic findings of the facial skin of excess sebum secretion. However, a shorter duration of efficacy, potential side effects, and the relative lack of evidence are common drawbacks to these treatments. The studies show that lasers and other energy-based treatments can reduce sebum production. However, many patients cannot tolerate, are unwilling to accept the side effects, are contraindicated for its use, or do not have severe enough disease to justify its use. One of the most effective inhibitors of sebum production is oral isotretinoin.
Facial seborrhea (“oily skin”), caused by an excessive sebum production in the facial skin, is also a major pathogenetic factor in several dermatologic disorders such as acne. The consequences of excess sebum may be associated with adverse psychological and social effects resulting from skin oiliness and shine and prominent pores. However, when produced in excess, it can be an aesthetic concern for many people since it frequently accompanies greasy skin and enlargement of facial pores ( Figure 1). Sebum production is physiologic and serves to lubricate the hairs and the stratum corneum. A sebaceous gland (SG) is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter called sebum.
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