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Abstract
Background: Psychopathological symptoms can exacerbate or induce cutaneous disorders. The side effect profile of psychiatric medications may reduce compliance in patients with primarily dermatologic complaints. OnabotulinumtoxinA injections are a common dermatologic intervention that recently demonstrated efficacy in reducing depressive symptoms. This systematic review investigates the anxiolytic effects of onabotulinumtoxinA in patients with comorbid anxiety. Methods: Following PRISMA guidelines, databases including APA PsycInfo, Embase, and PubMed were searched using MeSH terms related to onabotulinumtoxinA and anxiety. English-language primary research that examined the effects of onabotulinumtoxinA on anxiety was selected. Data regarding study design, participant demographics, indications, dosage, and anxiety scores were analyzed. Results: From 677 citations, 32 studies involving 41 patient groups met the criteria for inclusion in this review. The average population was 46 ± 14 years old and female (70 ± 24%). The most common indications for onabotulinumtoxinA included pain (46.3%) and chronic migraines/headaches (34.1%) with a mean dose of (251 ± 368 U). The severity of anxiety was assessed with validated scales in 94% and 81% of patients pre- and post-injection, respectively. At 4 ± 5 months post-onabotulinumtoxinA, 63% of patient groups revealed significant reductions in anxiety. Transient pain and muscle stiffness were the most common side effects, reported in 41.5% of groups. Conclusion: OnabotulinumtoxinA is a promising anxiolytic with a mild side effect profile. Further research will be needed to detail its efficacy relative to specific dermatologic indications, injection locations, and lasting effects.