Efficacy and Safety of Botulinum Toxin for the Treatment of Psoriasis: A Systematic Review and Meta-Analysis

Objective: To evaluate the current literature on Botulinum toxin (BoNT) use in psoriasis treatment, focusing on efficacy and safety. Botulinum toxin, known for its neuroprotective effects, is a promising therapeutic agent for inflammatory skin diseases.Methods: We searched electronic databases, including MEDLINE, Web of Science, and Google Scholar, from inception until March 2025 to identify randomized controlled trials and cohort studies in English that enrolled patients with psoriasis treated with BoNT injections over their lesions, reported outcomes related to the clinical question, and included raw numbers of outcomes.Results: Of the 342 retrieved articles, 166 duplicates were removed. Screening of titles and abstracts yielded 15 full-text articles, of which 6 encompassing 98 patients were included. The BoNT was administered intradermally at doses ranging between 2.4 and 7.5 units per injection site. A significant reduction in clinical severity scores post-treatment, including improvements in the Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores, was identified. Subgroup analysis of PASI scores suggested a potential clinical improvement, with reduced erythema levels. Post-treatment pain and recurrence were reported in 20.5% and 11% of patients.Conclusion: The BoNT shows potential as a treatment for localized psoriasis, with improvements in PASI and NAPSI scores and reduced erythema. However, evidence is limited by small, heterogeneous studies and insufficient safety data; larger controlled trials are needed to confirm efficacy, safety, and long-term outcomes.