Topical Anesthetic Cream...

...for cosmetic dermatologic procedures!


In A society like ours, of rejuvenating techniques increases and the baby boomer population continues to age, dermatologists will experience growth in the demand for cosmetic procedures. The most rapidly growing segment is in the arena of nonsurgical cosmetic procedures, which includes injectable fillers and Botox[R], laser skin rejuvenation, and hair removal. These procedures provide patients with rapid aesthetic improvement and require minimal post-treatment recovery time. There are a variety of topical lidocaine-containing anesthetic preparations available for use prior to these cosmetic dermatologic procedures that reduce patient discomfort, thus helping to provide a more comfortable treatment experience.



Topical Lidocaine

Lidocaine is the most commonly used topical anesthetic. It belongs to the amide class of anesthetics (including prilocaine and bupivacaine), which is used more often than the ester class of anesthetics (including procaine and tetracaine) due to the decreased incidence of allergic reactions associated with the amide class.

Although a multitude of lidocaine-containing topical anesthetic preparations exists, each differs in cost, formulation, and efficacy. Topical anesthetics may also vary with respect to recommended application time, necessity for occlusion, vehicle utilized, maximum safe dose, and duration of anesthetic effect. When selecting a topical anesthetic, it should be noted that combinations of various topical anesthetics can have additive toxicity potential. The risk of toxicity can also be amplified by application of lidocaine to a large surface area or application under occlusion.

The options available to anesthetize the skin continue to grow, particularly in the arena of compounded mixtures of lidocaine, which has no regulatory guidelines. Compounded topical anesthetic preparations (eg, benzocaine, lidocaine, tetracaine, or BLT?... I don't what that is. ) were recently implicated in 4 deaths after being applied to large surface areas prior to minor outpatient procedures. Such unfortunate outcomes accentuate the need for patient education on the proper usage and potential dangers of the medication being used. Specifically, the patient should be counseled on the appropriate use of the medication and its increased risk of side effects when applied:

1) under occlusion
2) to a large surface area
3) for periods longer than the manufacturer-recommended application time




Although the incidence of systemic adverse reactions is low, clinicians should be aware of the signs of toxicity which initially include drowsiness and tingling of the lips and later tinnitus, dizziness, muscle twitches, seizures, and eventually respiratory distress and coma. Because significant differences exist in the topical anesthetic products available, the manufacturer instructions for use should be closely followed in order to minimize the likelihood of side effects.