psd-502 and Vulvar-Diseases

Topics: Anesthetics, Local; Biopsy; Female; Hemostatic Techniques; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Vulvar Diseases

Case series have described disruptive histopathologic changes following lidocaine/prilocaine cream anesthetic for biopsies.. A study of histopathologic changes was performed following a randomized trial comparing topical lidocaine/prilocaine cream to 1% lidocaine injection anesthesia for vulvar biopsy. Histopathology was reviewed by two independent dermatopathologists blinded to the type of anesthetic. Specimens were scored on six histopathologic criteria described in the literature. Individual scores for each histopathologic feature and the total score across features were compared between the two groups using marginal models with generalized estimating equations.. Of 37 specimens reviewed, 19 were randomized to lidocaine/prilocaine cream and 18 to 1% lidocaine. Subjects exposed to lidocaine/prilocaine had the following odds of histopathologic changes, relative to lidocaine-exposed subjects: acantholysis (odds ratio 2.48; 95% confidence intervals [CI] 0.51, 12.06), clefting (2.42; 0.64, 9.14), pallor/necrosis (1.13; 0.28, 4.50), spongiosis (0.71; 0.18, 2.85), and papillary dermal edema (1.17; 0.41, 3.29). Total scores were not significantly different between treatment arms (risk ratio 0.98; 0.71, 1.35).. This histopathologic analysis of a randomized trial between lidocaine/prilocaine cream and injected lidocaine as anesthesia for vulvar biopsy shows the absence of significant disruptive histopathologic features secondary to the type of anesthetic. Additional studies in different clinical contexts are warranted.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Biopsy; Female; Humans; Lidocaine, Prilocaine Drug Combination; Middle Aged; Vulva; Vulvar Diseases

The efficacy of the anesthesia by the Emla cream (a mixture of lydocaine and prylocaine) has been tested on the cervix uteri and the vulva before laser treatment of warts and intraepithelial neoplasia. Five of the six women treated for vulvar warts did not feel any pain during laser treatment after the application of the cream. On the cervix, the pain was evaluated on a median of 9 on a visual scale going from 0 to 100, compared to a median of 25 for women treated without local anesthesia. The efficacy of local anesthesia was best after 4 minutes. The local anesthesia by the Emla cream seems to constitute a real progress in the patient's tolerance of local destructive treatment of cervical and vulvar warts and intraepithelial neoplasia.

Topics: Anesthetics, Combined; Anesthetics, Local; Condylomata Acuminata; Female; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine; Time Factors; Uterine Cervical Diseases; Uterine Cervical Dysplasia; Vulvar Diseases

EMLA(®) (eutectic mixture of local anesthetics, 2.5% each of lidocaine and prilocaine in an oil and water emulsion) is used as a topical anesthetic. We report three cases of EMLA(®) -induced histopathologic changes on the vulvar epithelium. While there are some similar histopathologic features to those reported in extragenital skin, we describe additional findings on vulvar epithelium, which, to our knowledge, have not been reported previously. The patients presented with clinical signs suggestive of lichen sclerosus or erosive lichen planus (LP), but were all confirmed histopathologically as LP. The biopsy was taken after 15 min of EMLA(®) application and intradermal injection of 1% lidocaine. Blistering prior to intradermal lidocaine and the biopsy procedure was observed in two patients. The histopathologic changes observed in the epithelium included pallor of the upper epidermis, mild spongiosis, intraepidermal subcorneal and suprabasal acantholysis, congestion of the papillary dermal capillaries and extravasated erythrocytes. Basophilic granules were present, but rare, while the necrosis with multifocal clefting was more marked than in extragenital skin. It is important to be aware of these changes occurring on genital mucosa; these may occur in the absence of clinical signs and may obscure the primary underlying pathology, thus representing a diagnostic pitfall.

Topics: Acantholysis; Administration, Topical; Aged; Aged, 80 and over; Anesthetics, Combined; Biopsy; Epidermis; Epithelium; Female; Genital Diseases, Female; Humans; Lichen Planus; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Prilocaine; Vulva; Vulvar Diseases

A number of minor urological surgical procedures can be readily carried out in children in outpatient clinics with the availability of a good topical local anaesthetic. In boys, the separation of preputial adhesions, frenulotomy, meatoplasty, meatal dilatation following circumcision or meatal surgery, the removal of smegma and excision of penile skin lesions can be performed as outpatient treatment. In girls, hymenal abnormalities, meatal abnormalities and labial adhesions come into consideration for its use. Success is dependent on a good estimation of the mental capacity of the child to undergo a local surgical procedure and correct use of the anaesthetic.

Topics: Ambulatory Surgical Procedures; Anesthetics, Combined; Anesthetics, Local; Child; Child Development; Child, Preschool; Circumcision, Male; Dilatation, Pathologic; Female; Humans; Hymen; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Minor Surgical Procedures; Ointments; Penile Diseases; Prilocaine; Smegma; Tissue Adhesions; Treatment Outcome; Urethra; Urethral Diseases; Urethral Stricture; Urologic Surgical Procedures; Vulvar Diseases

Topics: Anesthesia, Local; Anesthetics, Local; Biopsy; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Vulva; Vulvar Diseases