Decreased Labial Herpes Simplex Virus Outbreaks Following Botulinum Neurotoxin Type A Injection: A Case Report

October 2018 | Volume 17 | Issue 10 | Case Reports | 1127 | Copyright © October 2018


Erin Gilbert MD PhD,a Jia Zhu PhD,b Tao Peng PhD,b and Nicole L. Ward PhDc,d

aBrooklyn, New York, NY bDepartment of Laboratory Medicine, University of Washington and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA cDepartments of Dermatology and Neurosciences, Case Western Reserve University, Cleveland, OH dThe Murdough Family Center for Psoriasis, University Hospitals Cleveland Medical Center, Cleveland, OH

HSV reactivation is generally thought to go through small unmyelinated nerve fibers near the dermal-epidermal junction of skin, such as C-type fibers. BoNTA is known to cleave snap25, a presynaptic membrane protein that regulates neurotransmitter release, thus, it is likely that BoNTA inhibits HSV reactivation by inhibiting HSV egress from axons to infect keratinocytes. It is also tempting to think that BoNTA could inhibit virus replication in epidermal keratinocytes and DRG sensory neurons. How BoNTA affects HSV latency and reactivation in sensory neurons, viral axonal transportation and its accumulation at the varicosities of nerve terminals, warrants further investigation. We are currently exploring these questions in preclinical models as well as in human subjects.The off-label use of BoNTA in other non-dermatological areas, including the fields of neurology, pain management and urology is increasing as the utility of BoNTA continues to grow. Within dermatology, FDA-approved uses of BoNTA include treatment of glabellar lines, crow’s feet and hyperhidrosis and several recent reports show the success utilization of BonTA for the off-label treatment of medical dermatology conditions, including recalcitrant itch,5-7 with interest growing in its potential efficacy for treating skin conditions including rosacea and acne, as well as other neurogenic inflammation-driven cutaneous inflammatory conditions.In conclusion, we show here a significant decrease in the number of reported outbreaks of cutaneous HSV following prophylactic BoNTA treatment. We propose the use of BoNTA for treating recurrent HSV outbreaks is most suited for patients whose HSV is first driven into remission with standard-of-care treatment, acyclovir; followed by prophylactic administration of BoNTA into the skin regions most heavily affected by virus outbreak. Our report suggests that BoNTA may offer an affordable, durable, low maintenance approach to treating significant recurrent HSV outbreaks.

DISCLOSURE

Dr. Gilbert has served as a paid consultant for Merz, Allergan, Medicis, and Galderma; Dr. Ward has served as a paid consultant or speaker for Allergan and AbbVie, has had a research agreement with Allergan for unrelated studies, and receives research materials from Eli Lilly and Amgen.

REFERENCES

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AUTHOR CORRESPONDENCE

Nicole L. Ward PhD or Erin Gilbert MD PhD nicole.ward@case.edu or doctorgilbert@gmail.com
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