Dysport brings choice to cosmetic dermatology marketplace

Key Points

San Francisco - Clinicians have to apply different ratios when using Dysport (abobotulinumtoxinA, Medicis) in their patients,according to a clinical professor of dermatology at the University of California School of Medicine, San Francisco.

"It is a fine product, and the time has come to end the monopoly in the toxin marketplace," says Seth Matarasso, M.D., F.A.A.D., adermatologist based in San Francisco. "It is nice for physicians to finally have a choice. In the final analysis, you do what is best for thepatient."

There remains some confusion about its reconstitution, Dr. Matarasso says.

Dr. Matarasso says he uses a "20 percent" rule when using Dysport. If he uses 2 ccs of normal saline to reconstitute Botox(onabotulinumtoxinA, Allergan), then he would use 2.4 ccs of normal saline to reconstitute Dysport.

"I recommend that clinicians use about 20 percent more saline," he says.

Additionally, Dr. Matarasso suggests using 2.5 units of Dysport for every 1.0 unit of Botox that would be injected. This will ensure thatpatients are adequately dosed with Dysport.

"Using this protocol, it should be fairly easy for physicians to make the transition to Dysport (if they choose)," he says.

Dysport is approved by the Food and Drug Administration for injection into the glabella, with the goal to improve glabellar frown lines. LikeBotox, it has shown efficacy when used in an off-label fashion to treat other parts of the face and body.

The tolerability of both products is very similar, he notes.

"It is not that painful upon injection," Dr. Matarasso says. "They both have comparable acidity or Ph. The discomfort thatpatients experience with either product is very tolerable. They are different products, but they are more similar than they are different."

Diffusion confusion

Because Dysport has a lower molecular weight, there has been some concern regarding the product's diffusion to other areas.

"A lot of people are concerned that the molecular weight of Dysport is smaller, so there is more spread (with it), but I do not thinkthat we are seeing that," he says. "I think the concern is theoretical. Because it's about half the size (of Botox), it is thought itwould diffuse more. This has not been borne out in clinical experience."

That said, Dr. Matarasso cites one study conducted in Brazil that demonstrated greater diffusion with Dysport when used to treathyperhidrosis. However, for the treatment of conditions like axillary hyperhidrosis, he notes, greater diffusion may be desirable.

One of the advantages of the product is that it has a more rapid onset of action compared to Botox - an estimated 24 to 36 hoursearlier.

"It does kick in quicker," he says. "It is not all that important, but it is something that may be an issue for patients ifthey want a quicker onset of action. If, for example, a patient has an event coming up that the patient wants to attend, he or she may want to see quickresults."