Can Botox Help Treat Acne?

What the research actually shows.

Botox is best known for smoothing wrinkles, but researchers have recently begun exploring another potential benefit: its ability to influence oil production in the skin.

Because excess sebum is one of the key drivers of acne vulgaris, scientists have investigated whether botulinum toxin type A (BoNT-A) could play a role in reducing oily skin and acne formation. Studies suggest Botox may affect several biological pathways involved in acne, including sebaceous gland activity and inflammatory signaling.

To understand why this might work, it helps to look at how acne develops in the first place.

The Pathophysiology of Acne

Acne vulgaris is a multifactorial inflammatory condition involving several processes occurring within the pilosebaceous unit:

• Increased sebum production

• Follicular colonization by Cutibacterium (formerly Propionibacterium) acnes

• Abnormal keratinization leading to clogged pores

• Inflammatory signaling within the skin

Sebum production is a particularly important component. Excess oil can create an environment where clogged follicles and inflammatory acne lesions develop.

How Botox May Reduce Oil Production

The primary mechanism of botulinum toxin is the inhibition of acetylcholine release at the neuromuscular junction. This prevents muscle contraction and is why Botox relaxes facial muscles when used cosmetically.

However, acetylcholine receptors are also present on sebocytes, the cells responsible for producing sebum in sebaceous glands. Research suggests that when BoNT-A blocks acetylcholine signaling in these cells, it may modulate sebum production, leading to decreased oil output from the sebaceous glands.

Another potential mechanism involves the arrector pili muscles, the tiny muscles attached to hair follicles. These muscles assist in the secretion of sebum onto the skin surface. When Botox relaxes these muscles, sebum secretion may be reduced.

The Anti-Inflammatory Effects

Acne is fundamentally an inflammatory disease. BoNT-A appears to influence inflammation through several pathways.

One of the most studied involves substance P, a neuropeptide involved in inflammatory signaling and sebaceous gland stimulation. Substance P contributes to acne-related inflammation.Botulinum toxin has been shown to inhibit the release of substance P, which may:

• Reduce inflammatory signaling

• Decrease sebaceous gland activity

• Potentially improve acne lesion formation

By reducing neurogenic inflammation, BoNT-A may help limit the formation of new lesions and accelerate the resolution of existing acne.

Effects on Pore Size and Skin Texture

Patients with oily skin often report enlarged pores. Some research suggests Botox may influence the pilosebaceous unit, which includes the hair follicle, sebaceous gland, and surrounding structures.

By relaxing the arrector pili muscles around follicles, Botox may reduce mechanical tension on the follicle. This can theoretically lead to smaller-appearing pores and smoother skin texture, particularly in areas with high sebaceous activity such as the nose and central face.

What Studies Have Found So Far

Several clinical studies have examined the effect of both onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport) on sebum production and acne.

Reported outcomes include:

• 50 to 75 percent reduction in sebum production in treated areas

• Improvement in oily skin and pore size in approximately 85 percent of patients in some studies

• High patient satisfaction rates, reaching over 90 percent in certain trials

• Clearance of perinasal acne within 1 to 2 weeks, with improvements lasting several months

Some studies observed that sebum levels returned to baseline around 16 weeks, while others reported continued improvements up to 6 months after treatment.

Interestingly, research has also shown that lower doses than those used for traditional aesthetic treatments may still produce sebaceous gland effects.

What Botox Does Not Do

Despite promising findings, Botox does not treat the bacterial component of acne. There is currently no evidence that BoNT-A has antibacterial activity against Cutibacterium acnes. This means Botox does not address all factors involved in acne development. For this reason, Botox is not considered a standalone cure for acne.

The Bottom Line

Botox does not cure acne.

However, research suggests it may help improve several contributing factors, including:

• Excess oil production

• Neurogenic inflammation

• Pore appearance

• Sebaceous gland activity

Because acne is multifactorial, Botox may potentially serve as an adjunct treatment in patients, particularly those with very oily skin. As research continues, Botox may become part of a broader strategy for managing oily skin and acne in the future.

References

Birkett, L., Dhar, S., Singh, P., & Mosahebi, A. (2022). Botulinum toxin A in the management of acne vulgaris: Evidence and recommendations. Aesthetic Surgery Journal, 42(7). https://doi.org/10.1093/asj/sjac037

Dayel, S. B., Hussein, R. S., & Gafar, H. H. (2024). The role of Botulinum Neurotoxin Bont-A in the management of oily skin and acne vulgaris: A comprehensive review. Medicine, 103(8). https://doi.org/10.1097/md.0000000000037208