First case report of ustekinumab and botulinum toxin A injections in a patient

A 60-year-old woman receiving Ustekinumab for chronic plaque psoriasis for the past year sought advice on the safety of having concurrent facial botulinum toxin A for cosmetic purposes. Her main concern was whether it may cause a flare of her psoriasis. A search covering Medline, Embase and internal databases was done with ‘ustekinumab’ and botulinum toxin A showed no results. The patient was warned there is currently no data to suggest an interaction between ustekinumab and botulinum toxin A. The patient was also warned that ustekinumab is a selective immunosuppressant and may have the potential to increase the risk of infections and reactivate latent infections. She went on to have 110 units of (Dysport) botulinum toxin A to the glabella, forehead and crows feet. She reported no flare in her psoriasis or adverse effects up to one month post botulinum toxin A injections.
This highlights the need for further randomised prospective studies on the safety and efficacy of ustekinumab and concurrent therapies and concomitant therapies in psoriasis such as phototherapy and other immunosupressants. There exists data on psoriasis and ustekinumab with methotrexate that suggests it does not appear to influence the safety or efficacy of ustekinumab.[i] However, caution should be exercised when considering concomitant immunosuppressive agents.
1. Therapeutic Goods Association Product and Consumer Medicine Information for STELARA (ustekinumab) (25 November 2016) Janssen-Cilag Pty Ltd. Accessed from

Dr. Victoria Harris

Royal North Shore Hospital

Dermatology Research Fellow at Royal North Shore Hospital