From the Research
The development of small whiteheads at previous Botox injection sites for migraines, even after 5+ years, is likely due to a delayed hypersensitivity reaction or the formation of microcomedones in response to residual effects of the treatment. This could occur because Botox (botulinum toxin) can potentially alter local skin physiology long-term, affecting oil gland activity or creating microscopic changes in the skin structure that only become visible years later 1. The most recent and highest quality study on acne treatment suggests that first-line therapies are topical retinoids, benzoyl peroxide, azelaic acid, or combinations of topicals 2. Some key points to consider in the treatment of acne include:
- Topical retinoids are indicated for acne of any severity and for maintenance therapy 3
- Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks 3
- Isotretinoin is used for severe, recalcitrant acne 1, 3
- Gentle exfoliation with salicylic acid products (2% concentration) and topical retinoids like adapalene 0.1% gel applied nightly can be effective treatment options 4
- Benzoyl peroxide 2.5% can be used for more stubborn cases, and it does not induce bacterial resistance 5 It is essential to avoid picking or squeezing the whiteheads as this may cause scarring. If the condition persists or worsens, consult a dermatologist who might prescribe stronger treatments or determine if another skin condition is present. The delayed reaction could be related to how Botox affects nerve endings and surrounding tissues, potentially creating long-lasting changes to the microenvironment of the skin in those specific areas. In terms of treatment, topical retinoids like adapalene 0.1% gel applied nightly, or benzoyl peroxide 2.5% for more stubborn cases, are recommended 1, 2.