Prof. Dr. Antonino Di Pietro

Premessa: L’articolo che segue è fedelmente tradotto dall’originale pertanto si declina ogni responsabilità se viene riportato il nome commerciale Botox. Per una corretta informazione si ricorda che Botox è un farmaco che deve essere utilizzato esclusivamente per patologie neurologiche, mentre Vistabex, Azzalure e Bocouture sono il nome commerciale della stessa tossina botulinica che può essere utilizzata per scopi estetici.

“Come molte altre donne, Frankie Waring era convinta che avrebbe potuto contare sul Botox per tenere le rughe a bada. Per questo motivo, quando all’età di 24 anni, la giovane ha iniziato ad avere le prime rughe tra fronte e sopracciglia – come conseguenza, secondo i suoi sospetti, dell’esposizione della pelle agli elementi durante la passeggiate a cavallo – Frankie non ha avuto alcuna esitazione.

Si è così rivolta a una catena di cliniche pro-botox per porre rimedio al problema, pagando 225 sterline per delle iniezioni della tossina sulla parte superiore del viso. Nei giorni successivi, la giovane ha atteso speranzosa i primi risultati del “miracoloso trattamento” . Un’attesa che si è dimostrata totalmente vana. Le rughe erano ancora sulla fronte, visibili come sempre. Dopo un mese, Frankie si è rivolta ancora alla clinica, informando che il Botox non aveva avuto nessun effetto. La giovane è stata allora invitata a iniettare di nuovo la tossina a titolo gratuito.

Per l’ennesima volta, l’intervento si è dimostrato privo di esiti positivi: nessun effetto sulle rughe. Risultato, questo, che in realtà non deve sorprendere. Da quando è divenuto disponibile per uso cosmetico, il Botox è stato visto come una sorta di bacchetta magica nella lotta contro l’invecchiamento. Malgrado siano milioni i trattamenti che vengono svolti ogni anno, risulta però tuttora poco noto il fatto che non solo alcuni pazienti sono completamente immuni, ma anche che un crescente numero di donne che si sono sottoposte a iniezioni di botulino per troppe volte, stanno gradualmente sviluppando una resistenza alla tossina.

Si stima che tra lo 0,5 e il 3 per cento dei pazienti non mostra alcun tipo di risposta ai trattamenti. Un recente studio tedesco, pubblicato sul Journal of Neural Transmission, ha evidenziato che un utilizzatore di Botox ogni 200 sta sviluppando anticorpi alla sostanza in grado di neutralizzarne l’azione.

Il dottor Kuldeep Minocha dell’Harley Street’s Absolute Aesthetics Clinic, ha inoltre sottolineato di essersi imbattuto in sei casi di pazienti sui quali i trattamenti di botox non hanno avuto risultati. Il medico ha anche avuto modo di confrontarsi con utilizzatori come Frankie, ovvero persone dotate di un sistema immunitario particolarmente forte, capace di opporre totale resistenza alla tossina.”

Questi dati sono molto interessanti e rappresentano un’ulteriore prova del mio punto di vista. Ho infatti sempre sostenuto che la tossina botulinica crea assuefazione, per cui per ottenere buoni risultati bisogna rincarare la dose. Questo fatto porta a superare le quantità consigliate. Tutto ciò, oltre ad essere pericoloso per la salute, trasforma inevitabilmente i visi in una brutta maschera statica e inespressiva. Niente a che fare con ciò che si può definire “Vera Bellezza”.

L’ARTICOLO ORIGINALE

The women becoming immune to Botox: How over-use of the wrinkle-freezing drug is changing women’s bodies

Like many women, Frankie Waring assumed she would always be able to rely on Botox to keep her wrinkles at bay.

After all, while expensive creams and serums have never quite lived up to their promises, Botox has always enjoyed a reputation as the miracle anti-ageing quick fix that works every time.

So when Frankie, 24, started developing early lines between her eyebrows and across her forehead – due, she suspects, to exposing her skin to the elements while riding her horse – she had no hesitation deciding what to do next.

Frankie, from Worcester, who runs her own business making party banners, says: ‘I know I’m young, but my lines were really bothering me and I wanted to stop them before they got too serious.

‘I really wanted a nice smooth forehead again, so I went to a reputable national chain of clinics about six months ago who agreed Botox would be a good preventative measure. I then paid £225 to have two areas of my upper face injected.’

Over the next few days, Frankie watched for signs that the neurotoxin – made from the same bacteria that cause botulism food poisoning – was starting to take hold and paralyse her facial muscles as promised.

But she waited in vain. Whenever she checked, she could still wrinkle her forehead, and her frown lines stayed as visible as ever. After a month, she informed the clinic that the Botox had not worked – and was invited back for another dose at no extra charge.

‘It was a different nurse this time, who was just as experienced. I had loads more injections and they assured me they were using a full dose of the top-grade product – but again nothing.

‘I was really shocked. Never for a moment did I think it wouldn’t work for me. But now I have researched it, I have found out that I must be one of the people who is resistant.

‘I’ve always been the sort to never catch so much as a cough or a cold, so it makes sense really. I’m surprised it didn’t occur to me before that my body could fight it off.’

Since it first became available for cosmetic use in the UK just over decade ago, Botox has been seen as a magic bullet in the fight against ageing.

Yet despite the fact that over a million treatments are given in this country every year, it is a little known fact that not only are some patients immune to it altogether, but a growing number of women who have been getting the jabs too often, for too many years, are gradually building up a resistance to it.

It is estimated that anything between 0.5 and 3 per cent of patients don’t respond at all to the neurotoxin, which works by blocking messages in the nerve endings and weakening facial muscles for around four months at a time.

And a recent review by German researchers, published in the Journal of Neural Transmission, found that one in 200 regular Botox users was developing antibodies to the substance – white blood cells formed by the body when it is under attack – which stop it working.

Even the world’s biggest Botox manufacturer, Allergan, has acknowledged that ‘it’s possible, albeit rare’ to develop resistance, adding that the likelihood is higher in patients receiving larger doses for medical problems like muscle spasms or heavy sweating.

But when you consider that the number of people turning to Botox for cosmetic reasons is rising all the time – and that women are starting to use it at a younger age than ever – it seems likely that the number of cases may rise.

Dr Kuldeep Minocha, of Harley Street’s Absolute Aesthetics Clinic, says he has come across about six patients for whom Botox doesn’t work as well – or for as long.

‘Basically Botox is a foreign protein, and in some clients the body’s immune system may respond by producing “blocking” or “neutralizing” antibodies, which can stop the protein freezing the facial muscles. In other words, the body gets used to it and wears it down a bit quicker.

‘True resistance is rare, but some regular patients may find it doesn’t work as well or it wears out after six to eight weeks as the body metabolises it faster.’

He’s also come across patients, like Frankie, who just have an exceptionally strong immune system which resists the toxin altogether. He adds: ‘I often find, when I question these clients in detail, that they are the ones who “never get sick” – and don’t get coughs, colds, viruses.’

Consultant dermatologist Dr Nick Lowe, of the Cranley Clinic, says he is currently treating five Botox ‘non-responders’ at his London practice and many of his colleagues have reported cases of their own.

‘There are lots of different reasons why patients may become resistant or partially resistant,’ he says. ‘It’s similar to the way some people become resistant to antibiotics. It may be due to any number of different mechanics by which the toxin works within the cells.’

Dr Lowe says those most likely to stop reacting are those who have been taking it for years or those who ‘overdose’ by not leaving enough time between treatments.

‘There are clinics out there who send out letters every three months to remind patients to get topped up before it’s even worn off. It’s a practice which borders on unethical. I advise my patients to leave it as long as possible between treatments.’

Dr Lowe believes that a possible reason some patients don’t respond in the first place is that they have previously had low-dose food poisoning caused by botulism and developed an immunity as a result.

But Dr David Eccleston, of Birmingham’s MediZen Clinic, who lectures on Botox and trains other doctors to use it, believes a more common reason for Botox not working is that you get what you pay for. ‘No doubt some practitioners are finding business tough out there – and if you are getting a special deal at a hair salon or a Botox party, you are likely to be getting less toxin diluted with more saline.

‘It also may not have been stored properly – it must be transported in dry ice or it becomes less potent.’

How well it works is also down to the skill of the person giving it to you, Dr Eccleston stresses.
‘I have patients come to me and say their Botox didn’t work, but that was because it was injected into the wrong muscles or they didn’t get the right dose.’

However, for Melanie Lowe, a 35-year-old solicitor from Manchester, getting a watered down version doesn’t seem to be the problem.

Melanie started using Botox four years ago to iron out her expression lines. She first went to a dentist, who also gave her Botox injections, before moving to a specialist clinic. When it stopped working last year, she returned to both to learn why.

‘My dentist blamed the doctor I’d gone to after her, saying the dose she had given me must have been watered down. But I went back to the doctor and she opened the bottle in front of me and gave me two top-ups, which still didn’t work.’

Consultant plastic surgeon Abhilash Jain, of the University of Oxford and Imperial College NHS Trust London, believes that, as time goes on, we are likely to see more cases like Melanie’s.

For that reason, he is seeing new formulations of Botox coming onto the market – and suggests patients switch between the three existing strains of type A Botox (the type approved for cosmetic use), if what they’ve been using no longer works.

However, in his experience Dr Nick Lowe says switching between type A Botox brands doesn’t always overcome the problem. Instead, in resistant cases, he is turning to the type B strain of the botulism toxin, which works in the same way but on a different set of enzymes in the muscles.

‘In one patient who stopped responding after four sessions, I injected one half of his face with type A and the other with type B.

‘The side injected with type A stayed unchanged, but the wrinkles on the side treated with type B were immobilised.’

However, type B is not yet licensed for cosmetic use in the UK – only for body spasms. Although pioneers like Dr Lowe, who first helped introduce type A into this country, are currently carrying out type B trials, they are discovering drawbacks.

It only lasts eight to 12 weeks, compared to 16 weeks or more for type A. And as it has to be stored in acid, some patients find the injections more painful, and more anaesthetic has to be used.

Melanie still holds out hope that she won’t have to grow old gracefully. ‘It’s my 35th birthday next week so I’m feeling middle-aged with wrinkles galore again.

‘It’s depressing to feel so old and lined with no cure in sight. I hope that some other kind of poison can be invented in the near future.’

FONTE e COPYRIGHT: Dailymail