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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 8; 335(7618): 471.
PMCID: PMC1971181

US patients get faster access to botulinum toxin than for suspicious mole checks

It's quicker to arrange an appointment with a dermatologist for a cosmetic injection of botulinum toxin than for one to check potentially malignant changes in a skin mole, US research has shown. Two studies reported a year apart in the Journal of American Academic Dermatology have shown differences in waiting times for dermatology appointments.

In the latest study researchers posing as patients telephoned 898 dermatologists in 12 metropolitan areas to ask for a botulinum toxin injection (2007 Aug 27 doi: 10.1016/j.jaad.2007.07.020). Half offered appointments within a median of eight days. In comparison, a study a year earlier showed waiting times of 26 days for mole evaluation (2006;55:54-8).

The authors of the study, from the University of California, set out to determine why waiting times for regular and urgent dermatology appointments in the United States typically exceed three to four weeks. And they also wanted to evaluate patient access to dermatologists for cosmetic treatments. Respondents represented about one 10th of the country's practising dermatologists.

Botulinum toxin, which Stephen Arnon of the California Department of Health Services, has called “the most poisonous substance known,” is the first bacterial toxin to be used as a drug. In 2006 botulinum toxin injections became the most common cosmetic procedure in the United States. The injection has proved remarkably safe, but not all uses of botulinum toxin are approved by the US Food and Drug Administration.

Dermatologists are not the only healthcare professionals who give botulinum toxin injections. In the United States some nurse practitioners and physician assistants may carry out the injections, and legal requirements for those offering such services vary widely from state to state.

Jack Toole, president of the Canadian Dermatology Association, said that for patients with suspicious moles, getting to a doctor can be a challenging process emotionally because earlier diagnosis of skin cancer can be critical to survival.

But Canadians wait an average of 42 days for a dermatologist's appointment for medical reasons, Dr Toole told the Canadian Broadcasting Corporation (

A survey in 2006 indicated that 86% of Canadian dermatologists performed exclusively medical dermatology. But as public demand grows, dermatologists are increasingly turning to cosmetic procedures, such as botulinum toxin injections, which are not insured by the national healthcare system and which can cost patients hundreds of dollars.

Michelle Albagli, executive director of the Canadian Dermatology Association, says “any legally qualified medical doctor” can do the job. But dermatologists are often required to repair skin damage caused by botulinum toxin injections performed by less qualified staff, she adds.

The authors of the study said that they were unable to determine whether changing current appointment practices would have any impact on the longer waiting times for medical dermatology procedures. But because of shortages of doctors in other specialties that are increasingly offering cosmetic procedures, more cross specialty studies were warranted.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group