HPR volume 19 issue 8: news (7 August 2025)
Updated 7 August 2025
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Iatrogenic botulism outbreak associated with aesthetic procedures using injectable botulinum toxin products
The UK Health Security Agency (UKHSA) along with Medicines and Healthcare products Regulatory Agency (MHRA), local authorities and the NHS are investigating an ongoing outbreak of iatrogenic botulism in England.
From 4 June, 2025, to 6 August, 41 clinically confirmed cases of iatrogenic botulism have been reported to UKHSA from across five regions of England (the North East, East Midlands, East of England, North West and Yorkshire and Humber). Thirty-two of the cases were admitted to hospital with 8 requiring treatment in intensive care. All cases have reported having recent aesthetic procedures involving injections of botulinum toxin, with investigations showing that the majority of individuals received products that are unlicensed for use in the UK.
UKHSA and its partners issued an alert urging the public to take precautions when seeking aesthetic procedures and to seek medical advice if they experience symptoms suggestive of botulism such as:
- difficulty swallowing
- slurred speech
- breathing difficulties
The public have been advised to ensure they are receiving products that are licensed for use in England and that practitioners are sufficiently trained to give procedures involving injectable botulinum toxin. Advice is available on the NHS website to support the public in choosing who will undertake their cosmetic procedures.
Injectable botulinum toxin type products currently licensed in the UK for aesthetic procedures include Alluzience®, Azzalure®, Bocouture®, Botox®, Letybo®, Nuceiva® and Relfydess®.
Guidance is available through MHRA’s website to support the public and practitioners identifying potentially fake licensed products and online retailers and to report unlicensed products that are in circulation.