Q: I am a 38 years old woman having a dull look. I went to a clinic to understand my skin health. The doctor said that the dullness was due to the pigmentation and age. He advised me to take Botox 40 ml for my skin. Is taking Botox healthy? If I take it once, will I have to repeat it throughout my life? Please advise.

A:You have neither given the signs and symptoms of your skin problem nor the diagnosis. Hence a considered response is not possible. Botox is the brand name. It contains botulinum toxin type A. It is indicated in the treatment of strabismus in children and adults. Treatment of blepharospasm associated with dystonia, including benign blepharospasm and VIIth (facial) nerve disorders (specifically hemifacial spasm) in patients 12 years and over. Treatment of cervical dystonia (spasmodic torticollis).

Treatment of dynamic equinus foot deformity due to spasticity in juvenile cerebral palsy patients 2 years of age or older. Treatment of severe primary hyperhidrosis of the axillae. Treatment of focal spasticity in adults. Treatment of spasmodic dysphonia.

Cosmetic indications include temporary improvement in the appearance of upper facial rhytides (glabellar lines, crow's feet and forehead lines) in adults. The side effects vary from disease to disease. In general the following adverse events have been reported since the drug has been marketed: skin rash (including erythema multiforme, urticaria and psoriasiform eruption), pruritus and allergic reaction. There have been rare spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin type A. There have also been rare reports of adverse events involving the cardiovascular system, including arrhythmia (heart movement abnormality) and myocardial infarction (heart attacks), some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. New onset or recurrent seizures (fits) have also been reported, typically in patients who are predisposed to experiencing these events. Other reported side effects include: abdominal pain, blurred vision, brachial plexopathy, decreased hearing, diarrhoea, ear noise, erythema multiforme, fever, focal facial paralysis, localised numbness, loss of appetite, malaise, myalgia (muscle pain), myasthenia gravis (serious muscle weakness), pruritus, psoriasiform eruption, radiculopathy, sweating, syncope, vomiting and alopecia (loss of hair).