psd-502 and Molluscum-Contagiosum

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

Eighty-three 4- to 12-year-old children, scheduled for curettage of at least five molluscum contagiosum lesions, participated in a double-blind study. The children were randomly allocated to receive lidocaine/prilocaine (EMLA) cream (n = 58) or placebo cream (n = 25), applied 15, 30, or 60 minutes before treatment. The pain was assessed by the children and the physician as none, slight, moderate, or severe. In addition, the children rated the pain on a visual analog scale. EMLA cream effectively prevented the pain after all three application times (p less than 0.01). No significant difference in pain was observed among the 15-, 30-, and 60-minute EMLA-treated groups, but the proportion of children reporting no pain on the verbal scale increased from 36% in the 15-minute group to 61% in the 60-minute group. In the placebo group, only one of 24 children (4%) reported no pain. Transient local redness was the only skin reaction noted. In conclusion, an application time of EMLA cream of less than 60 minutes is satisfactory for the curettage of molluscum contagiosum in children.

Topics: Anesthetics, Local; Child; Child, Preschool; Curettage; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Molluscum Contagiosum; Prilocaine

A eutectic mixture of lidocaine and prilocaine (EMLA) is used topically to provide local anesthesia for a variety of painful superficial procedures. Although the side effects of EMLA are usually mild and transient local reactions, potentially life-threatening complications can occur. We report a case of generalized seizures and methemoglobinemia after topical application of EMLA for curettage of molluscum contagiosum lesions in a 3.5-year-old girl with atopic dermatitis.

Topics: Administration, Topical; Anesthetics, Local; Child, Preschool; Dermatitis, Atopic; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Molluscum Contagiosum; Prilocaine; Seizures

Molluscum contagiosum is a common, self-limiting viral disease of childhood caused by a poxvirus. Often the children themselves and their parents desire treatment for cosmetic reasons or because of pruritus. Laser therapy offers another option to the traditional methods of treatment.. 19 children aged between 2 and 13 years (median:6) with molluscum contagiosum were treated in a prospective, non-randomized pilot study with the flashlamp pumped pulsed dye laser (wave length:585 nm, pulse duration 0,45 ms, spot size 7 mm, energy density 6-7 J/cm(2)).. All patients tolerated the laser treatment well. In 84.3% one laser treatment led to total remission. In 10.5% a further laser session was necessary and one patient was treated three times to achieve total remission.. Treatment of molluscum contagiosum with the flashlamp pulsed dye laser is a safe and efficient treatment modality.

Topics: Adolescent; Anesthesia, Local; Child; Child, Preschool; Female; Humans; Lasers, Dye; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Molluscum Contagiosum; Pilot Projects; Prilocaine; Prospective Studies; Retreatment; Treatment Outcome

A 2-year-old girl lost consciousness after the topical application of lidocaine-prilocaine cream (EMLA) in preparation for the removal of multiple mollusca contagiosa. Both the area on which cream was applied (80% of body surface) and the total amount of cream (90 g) exceeded the maximum dosage. Lidocaine-prilocaine cream is a widely used local anaesthetic with few side effects when used properly. Intoxication with a lidocaine-prilocaine preparation may have serious consequences, such as changes in intracardiac conduction, excitation or depression of the central nervous system and methaemoglobinaemia. In our patient both methaemoglobinaemia and depression of the central nervous system occurred, resulting in loss of consciousness. She was treated with 100% oxygen and fully recovered.

Topics: Anesthetics, Local; Child, Preschool; Coma; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Molluscum Contagiosum; Ointments; Oxygen; Prilocaine; Treatment Outcome

Topics: Anesthetics, Local; Clinical Protocols; Coma; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Molluscum Contagiosum; Ointments; Prilocaine

We describe a 3-year-old child with mollusca contagiosa whose caregiver applied a eutectic mixture of 5% lidocaine and prilocaine (EMLA) in excessive amounts with the subsequent development of adverse reactions, including methemoglobinemia and hypoxemia. Because of the significant systemic absorption of lidocaine and prilocaine, the patient required overnight admission to the pediatric intensive care unit for close monitoring. A brief description of the proper dosing, pharmacokinetics, and possible side effects of EMLA cream are reviewed.

Topics: Administration, Topical; Anesthetics, Combined; Child, Preschool; Female; Follow-Up Studies; Humans; Hypoxia; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Molluscum Contagiosum; Prilocaine; Risk Assessment

Topics: Administration, Cutaneous; Anesthetics, Combined; Anesthetics, Local; Child; Epilepsy, Generalized; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Molluscum Contagiosum; Prilocaine; Time Factors

The plasma concentrations of lidocaine and prilocaine after dermal application of EMLA cream 5% were determined in two clinical studies. The cream (10-16 g) was applied to a total surface area of 100-160 cm2. Each area was covered by a Tegaderm dressing (3M) in order to obtain occlusion. An application time of 2 hours was used. Two age groups of ten children were studied: 2-3 years and 6-8 years. In both groups venous blood samples were drawn prior to application and at 2, 3, 4 and 5 hours. In addition, in one of the studies, the cream was used during the surgical removal of mollusca in order to study the analgesic effect of the cream. The absorption of the local anaesthetics as indicated by plasma concentrations was far below toxic levels. The highest individual concentration of lidocaine was 315 ng/ml and of prilocaine 215 ng/ml. The analgesic effect was sufficient--eight out of ten patients experienced no or slight pain. Transient local reactions (paleness, redness) were frequently observed. In one patient with eczema present at the application site prior to the application, a reaction persisted for one week. Dermal analgesia provided by EMLA is a safe and effective method for alleviation of pain from removal of mollusca and the plasma concentrations are innocuous.

Topics: Analgesia; Anesthetics, Local; Child; Child, Preschool; Curettage; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Molluscum Contagiosum; Ointments; Prilocaine

Using an percutaneous anesthetic Lidocaine ointment (EMLA cream 5%), we treated patients with mollusca contagiosa, condylomata acuminata, and verrucae plantaris by superficial curettage or electrocaustic surgery. The same presurgical procedure was applied in taking biopsies from the glans penis. The analgesia achieved was complete in all patients with mollusca contagiosa, condylomata acuminata, and penal biopsies. In those with verrucae plantaris, the anesthesia was incomplete but tolerable, also in children. We discuss the pharmacological effects of and further indications for this new percutaneous anesthetic ointment.

Topics: Anesthetics, Local; Biopsy; Condylomata Acuminata; Drug Combinations; Electrocoagulation; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Molluscum Contagiosum; Ointments; Penile Neoplasms; Prilocaine; Skin Diseases; Skin Neoplasms; Warts