State officials are investigating six cases of suspected botulism resulting from cosmetic Botox injections, and are warning health providers to be on the lookout for more.
On Thursday, the Massachusetts Department of Public Health issued an advisory about four suspected cases on the South Shore. Friday the department confirmed two more cases have been found.
It was unclear whether the individuals had been injected at the same location or how seriously they had been injured. Botulism can be potentially fatal, causing a variety of paralytic symptoms. State health officials said there was an ongoing investigation, and declined to specify additional details.
South Shore Health declined to answer questions about whether the health care system was treating suspected cases or how many it was seeing, referring instead to the Department of Public Health.
However Dr. Jason Tracy, chief medical officer at the health system, said generally that patients are given a presumptive diagnosis made off of their clinical presentation of symptoms and history of recent injections.
From there, the hospital would involve both the Department of Public Health and the Centers for Disease Control, which has an anti-toxin that it provides on a case-by-case basis. The anti-toxin helps slow the progression of symptoms, but does not reverse them, and so hospitals typically also provide supportive measures.
“This is quite rare,“ Tracy said. ”This is different than a food-borne botulism type case. It’s not as though there is a lot body of literature to refer clinicians to to give prognosis and historical elements and time courses for what to expect.”
Use of botulinum toxin — commonly known by the popular brand name Botox — for cosmetic procedures is widely understood to be safe. The powerful toxin, produced by a bacteria, blocks the ability of the nervous system to activate muscles. It has become known worldwide for its ability to both soften and prevent wrinkles, and it is the most common cosmetic procedure administered worldwide, with an estimated 3 million injections done annually.
Cosmetic treatments with botulinum toxin use doses much lower than for medical treatments, said Dr. Mathew M. Avram, director of the Mass. General Hospital Dermatology Laser and Cosmetic Center. With regulated, FDA-approved products in a healthy adult, the amount of the toxin is so small that it is exceedingly rare for it to cause botulism.
“I’ve never seen a patient or had a colleague of mine at Mass. General or elsewhere that has told me they have had a case of this. It is not something that happens normally,” Avram said. “Someone would have to go outside the realm of what you would typically inject to encounter these issues, for a typical patient.”
Beyond injecting far too much, poor administration technique or using counterfeit products can increase risks.
“We have seen instances where injectors have used counterfeit products or products they developed on their own,” Avram said. “These are unsafe practices that can harm patients.”
According to the advisory, botulism results when the botulinum toxin circulates in the blood. Symptoms including double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing. Such symptoms are sometimes followed by muscle weaknesses, which can progress over the course of hours or days.
DPH has asked clinicians to warn patients interested in these cosmetic injections of the potential risks, and is advising patients to receive injections only from licensed providers.
“If someone has had a botox injection and has had those symptoms they should seek medical attention,” Tracy said. “I don’t want to create worry but someone having visual changes, slurred speech and difficulty swallowing — they should not ignore it."
The reports are only the latest Botox problems to surface in the South Shore. In November, 38-year-old Rebecca Fadanelli, was arrested and charged with selling counterfeit Botox out of Skin Beauté Med Spa in Easton and Randolph.
Prosecutors say Fandanelli had for years imported counterfeit Botox, Sculptra, and Juvederm from China and Brazil and performed over a thousand injections, receiving over $900,000 in client payments. Though she represented to clients and employees that she was a nurse, prosecutors said she is an aesthetician and wasn’t properly licensed.
Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.