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Although causality has not been formally proven, the dermatological community strongly advises against off-label cosmetic use

doi: 10.3389/fsurg.2025.1618362 Received 25 April 2025 Accepted 28 August 2025 Published 15 September 2025 Volume 12 - 2025 Edited by Rafael De La Garza Ramos, Albert Einstein College of Medicine, United States Reviewed by Marica Eoli, IRCCS Carlo Besta Neurological Institute Foundation, Italy Hajnalka Rajnai, Semmelweis University, Hungary Zhenhua Li, Brigham and Women's Hospital and Harvard Medical School, United States Updates Copyright 2025 Guranda, Wach, Gresir, Braune, Kuzman and Nestler

18 The lesional cells usually reside deep in the connective tissue giving the lesion a bluish tint

ELISA can be used for the detection of toxin but none of the currently available assays are as sensitive as mouse bioassay (Cai & Singh 2007)

Peak Lab Peptides maintains quality-control processes and routinely performs third-party testing to support purity and identity verification

Toxin identification Mouse (or guinea pig) neutralization tests using a polyvalent antitoxin initially, followed by monovalent antitoxins, if they are available, are used to identify the toxin and the type of C