Safety of Botulinum Toxin for the Treatment of Children with Chronic Anal Fissure

Dear Sir/Madam,

We read with great interest the paper by Husberg et al. [1] published in your journal on the beneficial effects of botulinum toxin in the treatment of children with chronic anal fissure.

While we would like to thank the authors for their interesting article, we believe that more studies should be carried out to ascertain that the use of botulinum toxin is safe, especially in childhood and during pregnancy. Nelson [2] concluded in 2003 in a Cochrane review of the treatment of chronic anal fissure that medical therapy for chronic and acute anal fissure in children, including the use of botulinum toxin, may be used with a chance of cure. However there is a need for long-term follow-up studies to ensure the safety of such treatment.

The current use of the toxin seems to differ with regard to injection sites and dosages, emphasizing the need for double blinded randomized large-scale clinical trials. The cost-effectiveness of botulinum toxin is an important issue with regard to the need for repeat injections.

References

• 1 Husberg B, Malmborg P, Strigård K. Treatment with botulinum toxin in children with chronic anal fissure.  Eur J Pediatr Surg. 2009;  19 290-292
• 2 Nelson RL. Treatment of anal fissure.  BMJ. 2003;  327 354-355