The mere mention of the word Botox brings to mind fixed expressions on fading celebrity faces but not everyone who uses the cosmetic injections go to those extremes.  When used with discretion, Botox does an excellent job of making those nasty brow furrows disappear, even if only for a little while.  But many doctors see Botox as much more than just a pretty face; they see treatments for ailments head to toe.

Botox, the brand name for the purified version of the botulinum nerve toxin, has been around a long time.  Botulinum is the poison that causes botulism, a sometimes-fatal disease associated with poorly preserved foods.  The toxin made medical history - the good kind - in the 1970s when San Francisco ophthalmologist Dr. Alan Scott used it to successfully treat a patient’s crossed eyes.  He named his discovery Oculinum and it gained US Food and Drug Administration (FDA) approval in 1989 for the treatment of crossed eyes and twitchy eyelids.

In the 1990s, Allergan, maker of contact lens solutions and similar eye-care products, bought the drug from Dr. Scott and renamed it.  Allergan’s current chief executive officer, David E. I. Pyott, describes the purchase as sitting on a gold mine because the full potential of the nerve poison was basically unknown at the time.

Over time, the FDA has approved Botox for treating neck muscle spasms and to minimize excessive sweating.  As Botox Cosmetic, the drug is approved to cosmetically smooth wrinkles in the forehead.  Sales went from $90 million in 1998 to $1.3 billion last year, with about half that figure representing sales for medicinal, not cosmetic, uses.  Sales are expected to double in the next five to seven years, as the medical and investment communities both think of botulinum as a magic bullet.

Allergan and other pharmaceutical companies have plans to apply for FDA approval to use the toxin for a growing list of medical maladies:

• Migraine and sinus headaches;
• Inner ear disorders;
• Hair loss;
• Speech impediments caused by problems with vocal cords;
• Problems with chewing, swallowing, drooling, and clenched jaws;
• Oily or blotchy skin and pore size reduction;
• Ulcers;
• Pelvic muscle spasms;
• Overactive bladder;
• Benign enlarged prostate;
• Anal fissures;
• Phantom pains associated with amputated limbs;
• Limb tightness and spasms stroke victims experience;
• Cerebral palsy;
• Fibromyalgia; and
• Cosmetic fixes face to fender.

Even though not yet approved by the FDA for these uses, doctors have been successfully treating patients for these off-label conditions for years.

Botox comes with the risk of adverse effects if over-used or in individuals who don’t tolerate it well, just as all drugs do.  These concerns have led to FDA insistence on stronger warning labels for Botox and any similar drugs to be marketed under new and unique names.  Major complications have been rare thus far but several children, getting large doses of the toxin for cerebral palsy, died after injection.