The UK Health Security Agency (UKHSA) has issued a warning after more than forty people across England developed symptoms of botulism linked to cosmetic procedures involving botulinum toxin. The cases, confirmed between June and August 2025, are believed to be associated with unlicensed or counterfeit products used in aesthetic treatments.
Health officials have urged both practitioners and the public to remain vigilant and to ensure that only licensed medical products are used for injectable treatments.
Understanding Botulism and Its Causes
Botulism is a rare but life-threatening neurological illness caused by the Clostridium botulinum bacterium. The illness occurs when the bacteria produce toxins that disrupt communication between nerves and muscles, leading to paralysis.
Botulinum toxin works by blocking the signals that travel from nerves to muscles. When used correctly in medicine or aesthetics, it can relax targeted muscles safely. However, if misused or contaminated, it can cause widespread paralysis and respiratory failure.
There are several forms of botulism. Foodborne botulism occurs when toxins are ingested through contaminated food. Wound botulism develops when the bacteria infect damaged tissue. Iatrogenic botulism, the type linked to the current outbreak, results from the improper or excessive use of botulinum toxin during cosmetic procedures.
The Role of Clostridium Botulinum
Clostridium botulinum is an anaerobic bacterium that thrives in environments with little or no oxygen. It produces highly potent neurotoxins that can affect the body even in extremely small amounts. The spores can survive harsh conditions, including in inadequately sterilised food or contaminated injection materials.
The toxin’s potency, rapid onset, and long incubation period make it one of the most dangerous naturally occurring substances. Small quantities can cause severe neurological impairment within hours or days.
Recognising the Early Signs and Symptoms of Botulism
Early symptoms of botulism often include fatigue, weakness, drooping eyelids, blurred vision, and difficulty swallowing. These signs can be mistaken for less serious illnesses, which is why early detection is vital.
As the condition progresses, symptoms may worsen, affecting speech, facial movement, and the ability to breathe. Without prompt treatment, paralysis can spread to the respiratory muscles and become life-threatening.
Early medical intervention and antitoxin therapy can prevent the toxin from spreading and significantly improve recovery outcomes.
How Botulism Differs from Typical Food Poisoning
While food poisoning usually affects the digestive system, botulism targets the nervous system. Most foodborne illnesses cause nausea, vomiting, or diarrhea, but botulism causes muscle weakness and paralysis.
The key difference lies in the toxin’s mechanism. Botulism interferes with the body’s ability to send nerve signals to muscles, whereas typical food poisoning results from irritation of the stomach and intestines. Botulism is rare, but it is a medical emergency that requires immediate attention.
How Botulism Affects the Body
Botulinum toxin affects the body by blocking nerve signals that control muscle movement. When this happens, muscles become weak or paralysed.
The effects are most visible in the face and eyes, where patients may experience drooping eyelids, blurred vision, and facial weakness. As the toxin spreads, it can impair speech and breathing.
Simple examples help illustrate the process: Botulinum toxin causes paralysis. Patients experience muscle weakness. These effects are the result of disrupted communication between the nervous system and the muscles it controls.
Diagnosing and Treating Botulism
Diagnosis involves clinical assessment and laboratory testing to confirm the presence of botulinum toxin in the body. Doctors look for characteristic neurological signs and take detailed patient histories, especially regarding recent cosmetic treatments or possible food contamination.
Treatment focuses on halting the spread of the toxin. Antitoxin therapy is the main intervention and can stop further progression of paralysis, although it cannot reverse damage already done. Early treatment offers the best chance of recovery and reduces the risk of long-term complications.
Recovery and Long-Term Effects
Recovery from botulism can be slow. Patients may need intensive medical care and, in severe cases, mechanical ventilation to support breathing. Full recovery can take weeks or months, depending on the severity of the paralysis.
Some patients report lingering muscle weakness or fatigue after the initial illness. However, with early treatment and appropriate supportive care, most people recover without permanent damage.
Preventing Botulism and Reducing Risk
Botulism prevention relies on awareness and safe practice. In food preparation, proper canning, storage, and cooking are essential to destroy bacterial spores. Consumers should avoid eating food from damaged or swollen tins, as these can indicate contamination.
In cosmetic procedures, the key to prevention is ensuring that all injections use licensed and sterile products from trusted medical suppliers. The recent UKHSA warning highlights the risks of counterfeit and unlicensed botulinum toxin, often sold online or through unauthorised channels.
Dr Gauri Godbole, consultant medical microbiologist at UKHSA, said:
“We are working closely with our partners to reduce the public health risk and would advise people to make sure they take precautions when seeking aesthetic procedures.
Botulism related to aesthetic procedures is rare, but it can be serious. It is caused by toxins produced by the bacterium Clostridium botulinum. These toxins (but not the bacteria) are the active ingredient in botulinum toxin products.
Symptoms of botulism can take up to 4 weeks to develop and if you have had a recent botulinum toxin treatment and are having symptoms such as difficulty swallowing or breathing, contact NHS 111 for further advice and seek treatment.
If you are considering having a cosmetic procedure, please make sure to check that your practitioner is using a licensed product. On the NHS website there is more information on what sensible steps you can take when finding a practitioner.”
Ashley Simpson Davies, co-founder of Faces Consent, said that ensuring the authenticity of medical products used in aesthetic treatments should be a top priority across the industry.
“At Faces, we’ve partnered exclusively with legitimate UK pharmacies to guarantee that practitioners are purchasing genuine, approved toxins,” he said. “Our aim is to protect both practitioners and clients from the risks associated with counterfeit or unregulated substances.
We believe education and transparency are key to building trust in the aesthetic industry. Every practitioner using our platform can verify their suppliers and know they are working within safe, legal, and ethical boundaries.”
Public Health and Awareness
The UK Health Security Agency’s warning serves as a reminder of the importance of regulation and transparency in the cosmetic industry. Public health experts are urging both practitioners and clients to prioritise safety over cost and to report any adverse reactions quickly.
Botulism remains rare in the UK, but it is a clear example of how serious complications can arise when safety protocols are not followed. Awareness, vigilance, and regulation are the most effective defences against this preventable illness.
Source: UK Health Security Agency (UKHSA) and Medicines and Healthcare products Regulatory Agency (MHRA), gov.uk.
Information reproduced under the Open Government Licence v3.0.
Additional reporting and commentary © Faces Consent 2025.