{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:32Z","timestamp":1782107372674,"version":"3.54.5"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The increasing cosmetic use of botulinum toxin has been accompanied by poisoning events related to inappropriate administration, including excessive dosing, unapproved or unverifiable products, self-injection, and procedures performed outside regulated medical settings. However, the inpatient clinical profile and predictors of prolonged hospitalization remain insufficiently defined. This study aimed to describe the clinical characteristics of cosmetic botulinum toxin poisoning and identify factors associated with longer hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients hospitalized for cosmetic botulinum toxin poisoning at Guangzhou Twelfth People\u2019s Hospital between August 2024 and January 2025. Demographic data, injection-related characteristics, clinical manifestations, antitoxin treatment, hospitalization duration, and available clinical outcomes were extracted from medical records. Patients were divided into a short-stay group (&amp;lt;7\u202fdays) and a prolonged-stay group (\u22657\u202fdays). Univariate analyses and multivariable Cox regression were performed to identify factors associated with hospitalization duration. A nomogram was developed to estimate length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 145 patients were included, with a median age of 37\u202fyears; 97.93% were female. The most common injection sites were the forehead (26.35%), periocular region (16.77%), and jaw (11.98%). The most frequent manifestations were dizziness (89.66%), dysphagia (85.52%), blurred vision (75.17%), ptosis (68.28%), and slurred speech (24.83%). In multivariable Cox regression, duration of antitoxin therapy, dysphagia, and slurred speech were independently associated with prolonged hospitalization. A nomogram based on these variables showed acceptable calibration performance (MSE\u202f=\u202f1.302; MAE\u202f=\u202f1.029). No in-hospital deaths occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cosmetic botulinum toxin poisoning is characterized mainly by cranial nerve-related and bulbar manifestations. Dysphagia, slurred speech, and antitoxin treatment duration were independently associated with prolonged hospitalization. The nomogram may support early risk stratification and inpatient management, although external validation is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1836545","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:16Z","timestamp":1782106816000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and predictors of prolonged hospitalization in patients with cosmetic botulinum toxin poisoning: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yu-quan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-fan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-wen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-qiang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-qian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"865","DOI":"10.2174\/1389557520666200228105312","article-title":"Botulinum toxin as a biological warfare agent: poisoning, diagnosis and 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toxin injection for facial wrinkles","volume":"90","author":"Small","year":"2014","journal-title":"Am Fam Physician"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3394","DOI":"10.1111\/ene.16005","article-title":"Iatrogenic systemic botulism after intragastric botulinum neurotoxin injection: case report","volume":"30","author":"K\u0131lboz","year":"2023","journal-title":"Eur J Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1093\/asj\/sjaf088","article-title":"A retrospective case series study of illegal cosmetic iatrogenic botulism: outbreak analysis and response lessons","volume":"45","author":"Qiu","year":"2025","journal-title":"Aesthet Surg J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1001\/jama.296.20.2476","article-title":"Botulism in 4 adults following cosmetic injections with an unlicensed, highly concentrated botulinum preparation","volume":"296","author":"Chertow","year":"2006","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1001\/jama.285.8.1059","article-title":"Botulinum toxin as a biological weapon: medical and public health management","volume":"285","author":"Arnon","year":"2001","journal-title":"JAMA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"593","DOI":"10.15585\/mmwr.mm7438a1","article-title":"Notes from the field: severe illnesses after self-injection of botulinum toxin purchased online \u2014 New York, Texas, and Wisconsin, 2025","volume":"74","author":"Lamere","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e70082","DOI":"10.1002\/ccr3.70082","article-title":"Iatrogenic botulism after cosmetic use of botulinum toxin-a: a case series","volume":"13","author":"Asadi","year":"2025","journal-title":"Clin Case Reports"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e64976","DOI":"10.7759\/cureus.64976","article-title":"Self-administered botulinum injection causing rare masquerade of systemic botulism","volume":"16","author":"Tay","year":"2024","journal-title":"Cureus"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.jemermed.2016.07.097","article-title":"Delayed antitoxin treatment of two adult patients with botulism after cosmetic injection of botulinum type a toxin","volume":"51","author":"Fan","year":"2016","journal-title":"J Emerg Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0224700","DOI":"10.1371\/journal.pone.0224700","article-title":"Cost savings associated with timely treatment of botulism with botulism antitoxin heptavalent product","volume":"14","author":"Anderson","year":"2019","journal-title":"PLoS One"},{"key":"ref15","volume-title":"StatPearls","author":"Ni","year":"2023"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7002a1","article-title":"Clinical guidelines for diagnosis and treatment of botulism, 2021","volume":"70","author":"Rao","year":"2021","journal-title":"MMWR Recomm Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/bjd.16080","article-title":"The nonneuronal and nonmuscular effects of botulinum toxin: an opportunity for a deadly molecule to treat disease in the skin and beyond","volume":"178","author":"Grando","year":"2018","journal-title":"Br J Dermatol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s12893-017-0300-4","article-title":"Effective and rapid treatment of wound botulism, a case report","volume":"17","author":"Schulte","year":"2017","journal-title":"BMC Surg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1836545\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:17Z","timestamp":1782106817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1836545\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":18,"alternative-id":["10.3389\/fmed.2026.1836545"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1836545","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"article-number":"1836545"}}