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TL;DR
A 33-year-old woman developed herpes zoster on her forehead, scalp, and right upper eyelid one day after her first cosmetic botulinum toxin type A injection, confirmed by Tzanck smear and successfully treated with antiviral medication.
BMC Infectious Diseases · 10 authors, 4 centres
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A 33-year-old woman developed herpes zoster on her forehead, scalp, and right upper eyelid one day after her first cosmetic botulinum toxin type A injection, confirmed by Tzanck smear and successfully treated with antiviral medication.
This case report describes a 33-year-old woman who presented with progressive painful rashes, vesicles on her forehead, scalp, and right upper eyelid, fever, and malaise one day after her first cosmetic BTX-A injection for wrinkles. A positive Tzanck smear confirmed herpes infection. The patient was treated with antiviral medication, and symptoms gradually regressed over several days. The authors discuss a hypothesized mechanism in which botulinum toxin complex proteins act as antigens, triggering T cell exhaustion via sustained TOX expression and reduced CD4+ and CD8+ T cell production, thereby permitting VZV reactivation. Key limitations include the single-case design, absence of long-term follow-up, lack of ophthalmologist assessment for orbital edema, and missing information on the specific Botox brand used.