psd-502 and Dermatitis--Contact

Emla cream has been widely used as a local anaesthetic for superficial procedures. Blanching and redness are commonly observed side-effects. We observed purpura in 5 patients after application of Emla. Other authors have not reported this before. In 4 patients, purpura was observed after 30 min Emla application before the treatment of mollusca contagiosa. In 1 patient, Emla was used for 60 min before taking a lip biopsy. In these patients, patch tests were performed with the individual ingredients of Emla cream, Emla cream itself, placebo cream, and Tegaderm plaster. All tests were negative at an early reading after 30 min as well as after 2 and 3 days. We concluded that the purpuric reaction was not of an allergic nature. Possibly, it was caused by a toxic effect on the capillary endothelium.

Topics: Anesthetics, Local; Biopsy; Capillaries; Dermatitis, Contact; Drug Combinations; Endothelium, Vascular; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lip; Molluscum Contagiosum; Occlusive Dressings; Ointments; Patch Tests; Placebos; Prilocaine; Purpura; Time Factors

The analgesic effect and the occurrence of local reactions after repeated application of a lidocaine/prilocaine cream (EMLA 5%) were investigated in 31 haemodialysis patients. The cream was used for alleviation of cannulation pain prior to the haemodialysis (HD) for a period of 1-1.5 years. In each patient 300 to 312 applications of the cream were made during the period. Local skin reactions were recorded after the cream applications and the analgesic effect was evaluated with double-blind, crossover placebo controls at regular intervals. Seventeen patients completed the study. EMLA gave considerable pain relief and was significantly better than placebo at all effect evaluations but one. The frequency of local reactions was low and not correlated to the number of applications of EMLA. Two patients, however, interrupted their treatment due to local irritation.

Topics: Aged; Anesthetics, Local; Catheterization, Central Venous; Dermatitis, Contact; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Renal Dialysis

The Eutectic Mixture of Local Anesthetics (EMLA cream) is a topical anesthetic used for providing pain relief in patients undergoing superficial surgical procedures. Cutaneous side-effects have been reported rarely.. We present a case of irritant contact dermatitis induced by EMLA cream in a 6-year-old boy with Wiskott-Aldrich syndrome. Our patient showed clinically a well circumscribed patch corresponding to the site of application of the topical anesthetic. Histopathology showed confluent necrosis of keratinocytes in the upper epidermis, a mixed inflammatory infiltrate with priminent neutrophils in the upper dermis, and focal signs of interface changes including basal cell vacuolization and subepidermal cleft formation.. Graft-vs.-host-disease (GVHD), necrolytic migratory erythema, dermatitis enteropathica and pellagra should be considered in the histopathologic differential diagnosis of acute contact dermatitis caused by EMLA.

Topics: Acrodermatitis; Administration, Topical; Anesthetics, Local; Child; Dermatitis, Contact; Diagnosis, Differential; Drug Eruptions; Erythema; Graft vs Host Disease; Humans; Irritants; Keratinocytes; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Necrosis; Pellagra; Prilocaine

A eutectic mixture of 5% lidocaine and prilocaine was applied under occlusion for 1 or 2 hours on 25-100 cm2 areas of normal and diseased skin, and the absorption was followed by measuring the concentrations of the drugs in the draining vein and the general circulation at different time intervals after the application. The analgesic and vascular effects in the skin were also recorded. When the mixture was applied on normal skin the absorption was more rapid from the face than from the forearm. The absorption from diseased skin was faster than that from normal skin, with higher plasma concentrations, and a more rapid but shorter anesthetic effect was noted. With the doses used the plasma levels in the general circulation were 100 times lower than those associated with toxicity. The drug concentrations in the draining vein were highest after treatment of diseased skin and were 2-90 times higher than in the general circulation. The plasma concentrations of lidocaine and prilocaine ran parallel to each other, but the prilocaine level was 10-50% lower than that of lidocaine in the draining vein and 200-300% lower in the general circulation.

Topics: Anesthetics, Local; Dermatitis, Atopic; Dermatitis, Contact; Drug Combinations; Face; Female; Forearm; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Prilocaine; Psoriasis; Skin Absorption