H17: Botulinum toxin: from lethal adversary to dermatological sensation – how the power of poison was harnessed

Published Date: 05th July 2022

Publication Authors: Winters S

Abstract
Botulinum toxin, produced by the bacterium Clostridium botulinum, is a remarkably versatile agent. Its dermatological applications include the treatment of both hyperhidrosis and rhytides, and its myriad of medical functions are numerous and far reaching. Yet, capable of inducing paralysis and subsequent death, its origins belie the reputation it has garnered. In 1793, an epidemic in the German town of Baden-Württemberg claimed the lives of half of those afflicted. Dr Justinus Kerner, poet and district medical officer, noted an association between the fatalities and the consumption of uncooked blood sausages, culminating in the publication of the first accurate description of the symptoms of food-borne botulism. Kerner postulated that a toxin within the implicated sausage, so-called ‘Wurstgift’ or ‘sausage poison’, was the causative agent and that this agent may, indeed, also possess therapeutic benefit, but it was not until 1895 that Belgian bacteriologist Emile Van Ermengem identified the pathogen responsible. Investigating an outbreak of botulism following a funeral where a contaminated smoked ham had been served, Van Ermengem succeeded in isolating the toxin producing Bacillus botulinus (later renamed C. botulinum). From the latin ‘botulus’ (sausage), the bacterium was named as such due to its historical pathological relationship with the German staple. The first stable precipitate of the toxin was isolated in 1928 by P. Tessmer Snipe and Herman Sommer. As Adolph Hitler began his ascent to power, the dawn of the Second World War commanded a renewed interest in the toxin for its potential use as a biological weapon. The most potent poison known to man, Dr Edward J. Schantz and his team were commissioned to study its prospective military use: the toxin was successfully purified into a crystallized form, but weaponization proved impractical. Despite bleak beginnings, these wartime innovations paved the way for revolutionary medical application. Modern botulinum toxin treatment was pioneered by Alan B. Scott who undertook animal then first-in-human studies. Initially, a therapy limited to correction of ocular dystonias, a stroke of serendipity provoked the discovery of its wrinkle-erasing capacity when a patient being treated for blepharospasm by ophthalmologist Jean Carruthers commented that the injections bestowed a ‘beautiful, untroubled expression’. Alongside her husband, dermatologist Alistair Carruthers, the duo published their first report on the cosmetic application of botulinum in 1992, quickly catapulting the treatment to the realms of international infamy. Botulinum toxin, better known by its brand name, Botox®, now encompasses a multitude of therapeutic applications, including the treatment of hyperhidrosis, which has transformed the lives of countless dermatology patients. Amends have finally been made for this substance with a chequered past.

Winters, S. (2022). H17: Botulinum toxin: from lethal adversary to dermatological sensation – how the power of poison was harnessed. British Journal of Dermatology. 187(S1), pp.181-192. [Online]. Available at: https://onlinelibrary.wiley.com/doi/10.1111/bjd.21508 [Accessed 12 August 2022]

 

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