The UK Health Security Agency (UKHSA) has issued a warning to people seeking cosmetic procedures after 38 cases of botulism poisoning were linked to unlicensed Botox-like injections in England. The cases were reported between 4 June and 14 July 2025, initially in the north-east, with further cases in the east of England and East Midlands.
Investigations suggest the use of an unlicensed product, with symptoms including difficulty swallowing, slurred speech, and breathing difficulties requiring respiratory support. Botulism, caused by toxins from Clostridium botulinum bacteria, can be life-threatening and requires treatment with anti-toxins and supportive care.
Dr Gauri Godbole, consultant medical microbiologist at UKHSA, advised that symptoms can take up to four weeks to develop after treatment. She urged anyone experiencing signs such as difficulty swallowing to contact NHS 111 immediately. The agency has asked medical professionals to be vigilant for botulism in patients who have recently had cosmetic injections.
Dr Godbole stressed the importance of using licensed products and qualified practitioners. “If you are considering having a cosmetic procedure, please make sure to check that your practitioner is using a licensed product,” she said. The NHS website provides guidance on choosing a practitioner.
Prof Meghana Pandit, co-national medical director at NHS England, added that only registered professionals such as doctors, nurses, or pharmacy prescribers should prescribe these treatments. “When these procedures go wrong, there is a risk of serious infections and permanent scarring,” she warned.
Dr Alison Cave, chief safety officer at the Medicines and Healthcare products Regulatory Agency (MHRA), said buying Botox-like products outside regulated channels increases the risk of fake or unlicensed products. “Unlicensed products mean there are no safeguards to ensure they meet quality and safety standards, endangering public health,” she said.
