It is probably premature to declare Botox the penicillin of the 21st century, but the wrinkle remover is being put to some startling new uses.
In studies around the world, botulinum toxin is being tested — often with encouraging results — as a treatment for stroke paralysis, migraine headaches, facial tics, stuttering, lower back pain, incontinence, writer's cramp, carpal tunnel syndrome and tennis elbow.
Scientists are testing its ability to treat morbid obesity by weakening the muscle that lets food out of the stomach, to prevent ulcers by weakening the muscles that force gastric acids into the esophagus and to calm spasms in vaginal muscles that make sex painful. Botox is rescuing newborns with clubfoot from surgery and giving patients with spastic vocal cords back their voices.
Some trials are nearly ready for submission to the U.S. Food and Drug Administration, others are small and preliminary. But the toxin "has enormous potential" for relaxing muscles and treating some pain, including headaches, said Dr. Robert B. Daroff, the former editor in chief of Neurology magazine, who said he does not use botulinum toxin in his Cleveland neurology practice but became a believer after seeing migraine patients improve.
Dr. Jean Carruthers, an ophthalmologist at the University of British Columbia, compared it with penicillin for its versatility against a wide range of ills, and because it, too, is an organic product derived from a common bacterium.
The toxin has many advantages over other paralyzing and painkilling agents. It acts only where it is injected. It can be used merely to weaken a muscle instead of paralyzing it. It lasts for months, but it does wear off, so mistakes are reversible. In 25 years of use, it has harmed very few patients, and then only under rare circumstances.
A spokeswoman for the FDA declined to discuss uses the agency has not yet formally approved, but said the toxin was considered "very safe" for approved uses like making frown lines disappear.
"Every medical specialty is finding a niche for this drug," said Dr. Richard G. Glogau, a dermatologist at the University of California at San Francisco who in 2000 published a study showing that his wrinkle treatments were also curing his patients' migraine headaches.
Because it can even paralyze glands, the toxin could find uses as an injectable deodorant.
At Ludwig-Maximilian University in Munich, Germany, panelists who sniffed circles cut from the sleeves of T-shirts of 16 men who had been injected with botulinum toxin in one armpit and saline solution in the other found the toxin armpit odor much less unpleasant.
The toxin is "one of the most amazing compounds we've seen in the last two decades," said Dr. Marc Heckmann, a Munich dermatologist who led two sweat-control studies. He compared it in importance with the discovery of chemotherapy.