psd-502 and Skin-Diseases

: media-1vid110.1542/5852339542001PEDS-VA_2018-1173. To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia.. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions.. We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions.. Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias.. Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: -0.17 to 0.45; 6 trials,. Our results may not be applicable to older infants.. EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching.

Topics: Anesthetics, Combined; Humans; Infant; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Phlebotomy; Skin Diseases; Treatment Outcome

Topical anesthetics are increasingly important, as the number of outpatient surgeries for dermatologic problems in infants and children is steadily growing. This noninvasive modality of anesthetic delivery in conjunction with a reassuring environment may minimize the discomfort of otherwise painful procedures. Since the 1880s, when cocaine was first used as a topical ophthalmologic anesthetic, many ester-and amide-based local anesthetics have been developed for a variety of simple and complex procedures. The pediatric dermatologist's arsenal of topical anesthetic preparations is increasing with the development of novel vehicles of transdermal delivery and the use of anesthetics in combination. Eutectic mixture of local anesthetics is currently the most frequently prescribed topical agent, though the use of ELA-max, another lidocaine-containing preparation, is gaining momentum, especially in the neonatal population. Amethocaine, tetracaine, iontophoresis, and the S-caine patch, a product on the horizon for use in the pediatric population, also are included in this discussion.

Topics: Administration, Topical; Anesthetics, Local; Child; Drug Combinations; Humans; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Prilocaine; Skin Diseases; Tetracaine

Topics: Anesthesia, Local; Anesthetics, Local; Biopsy; Contraindications; Dermatology; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Skin Diseases

Numerous advances in surgery and laser therapy applicable to pediatric dermatologic practice have been made. The use of EMLA (eutectic mixture of local anesthetics; Astra USA, Westborough, MA) cream (lidocaine and prilocaine) is invaluable for office dermatologic procedures in children. Despite high patient tolerance, rare adverse events have been described. Newer topical anesthetics with faster onset and greater efficacy are discussed, with special emphasis on their application to the pediatric dermatology patient. Appropriately administered, these newer agents may make certain procedures in children painless or minimally uncomfortable. Newer, improved tissue adhesives are under development and may replace and surpass traditional surface suturing. Limitations to the use of the pulsed dye laser for vascular lesions in children are discussed.

Topics: Anesthetics, Combined; Anesthetics, Local; Child; Child, Preschool; Humans; Infant; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Office Visits; Prilocaine; Skin Diseases; Tissue Adhesives

A number of important therapeutic agents have recently become available for the treatment of infectious and inflammatory skin diseases. Five of these drugs, calcipotriol, EMLA (eutectic mixture of local anesthetics), interferon-alpha 2a, cyclosporine, and acyclovir, are reviewed. Calcipotriol, a vitamin D analogue, has been shown to be useful but not curative in chronic stable plaque psoriasis in adults. Its use in children is being studied. EMLA is proving to be useful in the prevention of pain prior to minor procedures. The use of interferon-alpha 2a promises to be highly effective in the treatment of the complications of vascular lesions. Cyclosporine is a powerful immunomodulating agent. It has been used in the treatment of atopic dermatitis and psoriasis. Adverse effects limit its widespread use as a systemic agent. Topical cyclosporine has limited efficacy due to its poor penetration. Acyclovir has revolutionized the treatment of herpes simplex virus infections, particularly in reducing the morbidity and mortality of neonatal herpes. Whether it is indicated in varicella infection in normal children is questionable.

Topics: Acyclovir; Anesthetics, Local; Calcitriol; Child; Cyclosporine; Dermatologic Agents; Drug Combinations; Humans; Interferon alpha-2; Interferon-alpha; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Recombinant Proteins; Skin Diseases

Needle puncture and infiltrational anesthesia is generally required for minor cutaneous surgical procedures and may be associated with anxiety, fear, discomfort, and pain. The use of topical anesthetics such as eutectic lidocaine/prilocaine 5% cream may provide an alternative means of delivering anesthesia.. Our purpose was to evaluate the effectiveness of eutectic lidocaine/prilocaine 5% cream applied under either occlusive adhesive dressing (Tegaderm) or patch formulation in providing analgesia for removal of lesions 40 mm long or shorter on the trunk or extremities; removal was effected by excisional biopsy or curettage with electrosurgery.. One hundred six patients (58 men, 48 women), 22 to 90 years of age, participated in this open-labeled, randomized, controlled, parallel group study. Patients were randomly assigned to receive either 2.5 to 5 gm of cream applied under an occlusive dressing or a 1.0 gm single-dose-unit patch. The topical anesthetic was removed 2 to 3 hours after application and just before surgery. This area was then tested for analgesia to pinprick. If analgesia was insufficient to the pinprick or during the surgical procedure, lidocaine infiltration was given. Patients rated the pain of the surgical procedure on a 100 mm visual analog scale.. After application times of 110 to 180 minutes, effective anesthesia was achieved in 87% of subjects. Treatment with the patch was equal to the cream/Tegaderm dressing in reducing pain experienced during surgery. No significant difference was found between the adhesiveness of the two dressings; however, the patch was easier to apply than the cream/ Tegaderm. No unexpected adverse events were observed.. For minor skin surgical procedures involving excisional biopsy or curettage with electrosurgery, eutectic lidocaine/prilocaine 5% cream/Tegaderm and patch formulations were equally effective and provided effective anesthesia in 87% of subjects. The patch formulation may be more convenient for self-application.

Topics: Adhesiveness; Adult; Aged; Aged, 80 and over; Analgesia; Anesthetics, Local; Biopsy; Curettage; Drug Combinations; Electrosurgery; Female; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Minor Surgical Procedures; Occlusive Dressings; Ointments; Pain Measurement; Prilocaine; Self Administration; Sensation; Skin Diseases

The flexion reflex threshold has been used as a measure of sensation in a group of premature infants born at 27-32 weeks postmenstrual age. The threshold in an area of local tissue damage created by routine heel lances was half the threshold on the intact heel on the other side. This indicated a hypersensitivity to tissue damage analogous to tenderness or hyperalgesia reported in adults. In a double-blind study, treatment of the damaged area with the topical anaesthetic cream, EMLA, was found to reverse this hypersensitivity or in other words increase the flexion reflex threshold. Treatment with placebo had no effect. The results show that the newborn infant central nervous system is capable of mounting a chronic pain response to local injury which can be reduced by local anaesthetic.

Topics: Anesthetics, Local; Ankle Injuries; Blood Specimen Collection; Double-Blind Method; Drug Combinations; Female; Humans; Hypersensitivity; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Longitudinal Studies; Male; Prilocaine; Reflex; Sensory Thresholds; Skin Diseases; Wounds, Penetrating

Topics: Anesthetics, Local; Child; Child, Preschool; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Retrospective Studies; Skin; Skin Diseases

Topics: Administration, Topical; Anesthetics, Local; Child; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Skin Diseases; Tetracaine

Laser therapy is now accepted as the treatment of choice for port wine stains. Patient reaction to laser light exposure and methods used to control pain during 1357 treatment sessions for 350 medium to large port wine stains using the SPTL-1 laser (Candela Laser Corporation) are reported. In the majority of cases (86%) it was necessary to use either general anaesthesia or some other form of local pain control.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Facial Dermatoses; Hamartoma; Humans; Ice; Laser Therapy; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Prilocaine; Skin Diseases

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