psd-502 and Hemangioma

The control of pain associated with laser treatment of port-wine stains in children has been problematic. Using EMLA, a topical anesthetic, children can be treated with a significant reduction in laser-induced pain. In this prospective, double-blind, placebo-controlled, randomized trial of EMLA, 73 children (35 boys and 38 girls) ranging in age from 5 to 16 years with port-wine stains were treated. EMLA reduced mean pain scores 66% when compared with control subjects (p < 0.0001 for all three assessments of pain). Concordance between evaluators' and patients' assessment of pain scores correlated strongly (p < 0.001). Treatment with EMLA abolished pain in 40% of patients and the percentage of pain-free treatments increased from 10% to 52% (p < 0.001). EMLA is clearly effective in reducing or eliminating pain associated with laser treatment of port-wine stains in children.

Topics: Administration, Cutaneous; Adolescent; Anesthesia, Local; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Female; Hemangioma; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Prilocaine; Skin Neoplasms

Vascular-specific lasers with pulse durations of between 300 and 500 microseconds are the treatment of choice for portwine stains (PWS), particularly in children. Although the discomfort felt following laser irradiation from a single pulse is transient, these sensations are intensified when multiple pulses are delivered over a confined area of skin. Because 75-80% of PWS are located in the head and neck regions, laser treatment of these sites tends to be more painful than those located in most other parts of the body. A prospective double blind randomized study, assessing pain during laser irradiation on PWS skin occluded with either EMLA, placebo, or no cream (control) was performed in 73 PWS subjects between 5 and 16 years of age. Analysis of the data showed that the pain scores for EMLA-treated sites were the smallest, the control scores tended to be the highest, with the placebo scores in the middle. The differences between the treatments were significant (P < 0.0001).

Topics: Adolescent; Anesthetics, Local; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Hemangioma; Humans; Laser Therapy; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain Measurement; Prilocaine; Prospective Studies; Skin Neoplasms

Topics: Anesthesia, General; Anesthesia, Local; Child; Child, Preschool; Facial Neoplasms; Hemangioma; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Patient Compliance; Prilocaine; Risk Factors; Skin Neoplasms

Topics: Anesthesia, Local; Anesthetics, Combined; Female; Hemangioma; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Prilocaine; Skin Neoplasms

Topics: Anesthetics, Local; Child; Drug Combinations; Female; Hemangioma; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Prilocaine; Skin Neoplasms

EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Female; Hemangioma; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Skin Neoplasms