Granuloma annulare after Botulonium toxin A injection: A rare association

Background: Botulinum toxin is generally considered safe and has been used in constantly expanded cosmetic and therapeutic indications. However, long-term side effects such as granulomatous reactions have been associated with this drug.

Aims: We aim to evaluate a rare reaction to Botulonium toxin A injection.

Patients/methods: A 44-year-old woman, developed annular plaques eleven months after botulinum toxin A injection for the correction treatment of wrinklesglabellar rhytides.

Results: Histopathological examination revealed granuloma annulare formation. Clinical and biological investigations were negative, ruling out the hypothesis of systemic sarcoidosis. Triamcinolone acetonide injection was followed by a regression of the plaques.

Conclusion: There are previous reports in the literature of sarcoidal and foreign body granuloma at the sites of injection of botulinum toxin A injection. To our knowledge this is the first report of granuloma annulare occurrence after botulinum toxin A injection.