Background:Acne vulgaris is a common inflammatory disorder involving the pilosebaceous unit. The pathogenesis is multifactorial, involving four key factors with interrelated mechanisms: increased sebum production, hyperkeratinization of the follicular infundibulum, inflammation, and Cutibacterium acnes. Botulinum toxin (BoNT)is a potent neurotoxin protein derived from the clostridium botulinum bacterium. It exerts its effect at the neuromuscular junction by inhibiting the release of acetylcholine, which causes temporary chemical denervation. At the cellular level, botulinum toxin functions by cleaving a synaptic protein (synaptosomal-associated protein of 25 kDA [SNAP-25]) on the internal surface of neuronal membranes, thereby inhibiting vesicle fusion and release of acetylcholine