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Patients who received PDL with EMLA cream and PDL with a placebo at the same anatomic site. The photographs were taken at pretreatment (a, c, e) and 2 months after the final (or third) treatment (b, d, f)
Source publication
EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen...
Citations
... EMLA is a local anesthetic that is applied to the skin or mucosa during painful therapeutic procedures, such as foreskin surgery, cryosurgery of verrucae, vaccinations, medical cosmetic treatment and so on. EMLA use has been proven to be safe, without interactions associated with laser treatments or other cosmetic procedures [1]. Thus far, some mild adverse reactions have been reported, including erythema, blister, urticaria, allergic contact dermatitis, irritating contact dermatitis and pigmentation [2]. ...
BACKGROUND
Lidocaine/prilocaine (EMLA) cream is a local anesthetic that is applied to the skin or mucosa during painful therapeutic procedures with few reported side effects.
CASE SUMMARY
Here, we report the use of dermatoscopy to identify a case of erythema with purpura, a rare side effect, after the application of 5% EMLA cream.
CONCLUSION
We conclude that erythema with purpura is caused by irritation and toxicity associated with EMLA, but the specific mechanism by which the toxic substance affects skin blood vessels is unclear. In response to this situation and for cosmetic needs, we recommend tranexamic acid, in addition to routine therapy, to prevent changes in pigmentation in patients with dermatitis.
... Several strategies for controlling the pain during treatment have been explored, such as cold-air analgesia, oral or intravenously administered analgesia, and nerve blocks (8). Although some of them achieve a reduction in the levels of pain, none were completely effective and convenient (9)(10)(11). General anesthesia, the most common pain management strategy in anesthesia care, has been extensively used in clinical practice, such as for total knee replacement, lumbar laminectomy with instrumentation, exploratory laparotomy, and cesarean delivery (12). ...
Background
Hemoporfin-mediated photodynamic therapy (PDT) is an effective treatment for port-wine stains (PWS), and pain is the main adverse effect of this therapy. General anesthesia is commonly used for pain management during PDT, but the effect of general anesthetics on the subsequent treatment efficacy of PDT in PWS has not been reported.
Objectives
To assess the use of general anesthesia combined with PDT compared with PDT alone in 207 PWS patients, and to provide further safety and efficacy data on this combined therapy.
Methods
Propensity score matching (PSM) was used at a 2:1 ratio to create a general anesthetic group ( n = 138) and a highly comparable nonanesthetic group ( n = 69). The clinical outcomes were evaluated, and the treatment reactions and adverse effects were recorded after one treatment with PDT.
Results
After matching, there was no significant difference in the demographic data of the patients in the two groups ( p > 0.05), while the treatment efficacy was significantly higher in the general anesthetic group than in the nonanesthetic group (76.81 vs. 56.52%, p < 0.05). Moreover, logistic regression analysis confirmed that patients receiving general anesthesia showed an association with a good response to PDT (OR = 3.06; 95% CI, 1.57–6.00; p = 0.0011). Purpura lasted longer in the general anesthetic group, but the other treatment reactions and adverse effects were similar in the two groups ( p > 0.05). No serious systemic adverse reactions were observed.
Conclusion
We recommend this combined therapy, which is associated with painless, as a high efficacy treatment option for PWS patients, especially for patients with a poor response to multiple PDT alone treatments.
... Yu W et al. demonstrated that whilst treating port-wine stains with a pulsed-dye laser, using EMLA for pain control does not lead to increased side effects as well as helpfully reducing pain during treatment. Moreover, they concluded that EMLA cream is safe and effective as topical local anesthetic [21]. The results of their study are in contrast with ours, as we reported side effects from EMLA use, but this may be due to different sample sizes, demographics, expedients in the EMLA or because of its use in a different setting. ...
... Given its moderate lipophilicity, it has been hypothesized that the SC represents the main diffusional barrier for its transcutaneous delivery [55]. Despite the fact that marketed composition containing penetration enhancers (EMLA®) was reported to increase anesthesia up to 500 µm depth into the skin [56], several authors claim that, specially before injections, minimal benefit is observed compared with control as pain was still experienced in many of the subjects [57,58]. Consequently, new alternatives (i.e. ...
The use of pressure waves (PW) to disrupt the stratum corneum (SC) temporarily is an effective strategy to increase the deposition of drug molecules into the skin. However, given the rather modest outcomes when compared with ablation-assisted drug delivery, its potential has been underestimated. Accordingly, the aim of this study was to examine the impact of Resonant Amplitude Waves (RAWs) on increasing cutaneous delivery. RAW phenomena are triggered by focusing a high-peak-power pulsed laser onto an appropriate transducer structure, under space- and time-controlled resolution.
In order to determine the optimal conditions for the generation and use of RAWs, a screening of laser parameters setting and an analysis of different geometries of the impact pattern over diverse materials used as transducers was performed, analyzing the footprint of the RAW waves in an agarose gel. The results obtained were then checked and fine-tuned using human skin samples instead of agarose. Furthermore, ex vivo experiments were carried out to characterize the effect of the RAWs in the cutaneous delivery of diclofenac (DIC) and lidocaine (LID) administered in the form of gels. The application of RAWs resulted in an increased delivery of DIC and LID to the skin, whose intensity was dependent on the composition of the formulation. In fact, the maximum observed for DIC and LID in short-time experiments (39.1 ± 11.1 and 153 ± 16 µg/cm², respectively) was comparable to those observed using ablation-assisted drug delivery under the same conditions.
In conclusion, the combination of RAWs with specific formulation strategies is a feasible alternative for the cutaneous delivery of drug candidates when short onset of action is required.
The use of laser technology in medicine was pioneered in the 20th century. Since the first application in the treatment of pigmented lesions in 1960, lasers have evolved to become a mainstay of treatment in medicine and surgery alike. Lasers are routinely used to treat a wide variety of skin disorders. Given the vast array of laser devices currently available, the laser dermatologist must understand the capabilities and limitations of each device and the applications, including target structure and the appropriate parameters for the desired target, and the possible complications.
Pulsed dye laser (PDL) is the most commonly used method for port-wine stain (PWS); however, no studies have reported the safety of PDL. This review aimed to collect and summarize complications reported in relevant literature, assess complication rates in treating PWS with PDL, and explore the relevant influencing factors. A systematic review and meta-analysis were conducted to search for related studies in PubMed, Embase, and the Cochrane Library until August 2022. Two reviewers independently evaluated the risk of bias of included studies. Stata Software version 17.0 was used for the analysis. All complications reported in the literature are divided into acute phase complications and long-term complications. Overall pooled purpura, edema, crusting, blistering, hyperpigmentation, hypopigmentation, and scarring rates were 98.3%, 97.6%, 21.5%, 8.7%, 12.8%, 0.9%, and 0.2%, respectively. Although the acute adverse reactions were found to be common, the long-term permanent complications clearly have a lower frequency, and the occurrence of scarring is much lower than that initially thought. This indicates that effective protective measures after treatment are very important for preventing scar formation. Overall, PDL treatment for PWS shows a high level of safety and low chances of causing long-term complications.
Background:
The surgical management of macrocheilia secondary to port-wine stains is complicated.
Objective:
This study aimed to propose an innovative method for treating macrocheilia on the lower lip.
Methods:
Patients who underwent the reconstruction of macrocheilia on the lower lip through the innovative approach were examined. Their preoperative and postoperative standard photographs were taken to evaluate the changes in lip length and thickness. The scores on Vancouver scar scale (VSS) and visual analog scale (VAS) were evaluated.
Results:
Thirty-two patients who underwent the reconstruction of macrocheilia were examined. A follow-up of 12.2 months (6-36 months) was conducted. The lower lip contour and the mentolabial groove were reconstructed to normal appearance. The lip length was shortened from 5.38 ± 0.49 cm pretreatment to 4.59 ± 0.30 cm posttreatment (p = .016). The exposed vermilion was shortened from 2.05 ± 0.48 cm to 1.26 ± 0.12 cm posttreatment (p < .01). The mean VSS and VAS scores were 2.2 ± 1.5 and 8.4 ± 1.3, respectively.
Conclusion:
The bilateral limited excision and stepwise single-stage approach were safe and effective for reconstructing prominent macrocheilia on the lower lip. The technique was also easy to command for the beginners.
Background:
Topical anesthesia has vasodynamic effects within the skin and therefore has the potential to change the presence of hemoglobin as a chromophore before intense pulsed light (IPL) and vascular laser treatments. It is unclear whether this is clinically relevant. Global consensus on the use of topical anesthetics in this context is lacking.
Objective:
Review the effects of topical anesthetics on the skin microvasculature and the clinical implications of such effects on vascular treatments.
Methods:
PubMed and Medline searches were performed to identify studies examining the vasodynamic effects of topical anesthesia on skin and evaluating differences in efficacy of IPL and vascular laser treatments with or without topical anesthetic use.
Results:
Published studies reveal variable effects of different topical anesthetic agents on skin microvasculature. Only 3 controlled studies that directly examined the effect of topical anesthesia on clinical outcomes for pulsed dye laser (PDL) treatment of vascular conditions were identified. They did not support a difference in clinical outcomes with or without the use of topical anesthesia before PDL treatment.
Conclusion:
Although topical anesthetic agents have vasodynamic effects within the skin, there is currently insufficient evidence to advise against their use before light and laser-based vascular treatments.
In der vorliegenden Studie wurde eine Lidocain/Prilocain-haltige Creme (EMLA® Creme) in Anwendung zur postoperativen lokalen Analgesie bei Kaiserschnittpatientinnen getestet. Die Studie beschäftigt sich mit den Forschungsfragen, ob die zusätzliche Therapie mit EMLA® Creme postoperativ den Schmerzverlauf verbessern, die Dauer bis zur Mobilisation und bis zur Entlassung aus dem Krankenhaus verkürzen sowie die zusätzlich eingenommene Menge an Analgetika, insbesondere Opiaten, vermindern kann. Die Untersuchung wurde mittels prospektivem, zweiarmigem und randomisiertem Studiendesign getestet und unter Verblindung der Probandinnen und dem pflegerischen sowie ärztlichen Personal durchgeführt. Von insgesamt 189 rekrutierten Patientinnen konnten 139 vollständige Datensätze genutzt werden. Bei allen Probandinnen wurde in der Frauenklinik des Universitätsklinikum Mannheim eine elektive primäre Sectio caesarea durchgeführt. Die untersuchten Kollektive unterschieden sich nicht im Hinblick auf demographische oder chirurgisch-operative Parameter. Die Versuchsgruppe („V“, n = 62) erhielt das Präparat EMLA® Creme und die Kontrollgruppe („K“, n = 77) Bepanthen® Salbe. Je ein Gramm der Präparate wurden unmittelbar nach dem primären Kaiserschnitt sowie 24 Stunden später auf die Hautnaht des Kaiserschnittes aufgetragen. Beide Gruppen erhielten eine postoperative Standardanalgesie sowie Bedarfsanalgesie. Der postoperative Schmerz wurde durch den short-form McGill pain questionnaire (MPQ-SF) nach 24 und 48 Stunden erfasst. Der primäre Endpunkt McGill total betrug nach 24 Stunden im Median 38,5 (Range 0 – 102) (V) versus 50 (0 – 120) (K) Punkte, was mit einem p-Wert von 0,0889 keinen signifikanten Unterschied bot. Nach 48 Stunden betrugen die Werte 24 (0 – 19,5) (V) versus 30,5 (0 – 92) (K) Punkte, was ebenfalls nicht signifikant verschieden war (p = 0,1455). Des Weiteren gab es bezüglich des normativ geschätzten Schmerzindex (McGill 1), der aktuellen Schmerzintensität (McGill 2) und der Beurteilung der Intensität der gesamten Schmerzerfahrung (McGill 3) nach 24 und 48 Stunden keine signifikanten Gruppenunterschiede. Bei Einteilung der Probandinnen in die Stufen 1-3 nach dem WHO-Stufenschema (moderater, starker und sehr starker Schmerz) anhand der konsumierten Menge an Analgetika zeigte sich kein Gruppenunterschied (Stufe 1: 36,36% (V) versus 40% (K), Stufe 2: 58,18% (V) versus 60% (K), Stufe 3: 5,45% versus 0% (K); p = 0,3483). Im Vergleich der kumulativen Dosis der einzelnen Analgetika zeigten sich ebenfalls jeweils keine Unterschiede. Auch im Hinblick auf die Zeit bis zur Mobilisation sowie die Zeit bis zur stationären Entlassung zeigten sich vergleichbare Zeitintervalle ohne signifikante Unterschiede. Nebenwirkungen der Präparate traten bei nur einer (V) beziehungsweise vier (K) Probandinnen ohne signifikanten Unterschied auf (p = 0,3807). Ebenfalls ohne signifikanten Gruppenunterschied in allen Punkten fiel die Beurteilung der Wundnaht durch den behandelnden Arzt aus. Die postoperative topische Anwendung von EMLA®-Creme bei Zustand nach Kaiserschnitt zeigte zusammenfassend keinen positiven Effekt auf den postoperativen Schmerz, den postoperativen Konsum von Analgetika und insbesondere Opioiden, die Zeit bis zur erfolgten Mobilisation sowie die Zeit bis zur Entlassung in die Häuslichkeit. Folglich ist die Anwendung von EMLA®-Creme im klinischen Alltag in dieser Indikationsstellung kritisch zu sehen
Aim
Pain control is an important aspect of ED patient management, and there are many different protocols used around the world influenced by both availability of local resources as well as staff competency and experience. This study aims to evaluate the use of topical ketamine in acute pain reduction by directly comparing it to lidocaine-prilocaine (EMLA) cream.
Materials and methods
In this randomized clinical trial, 300 adult patients classified as level 4 or 5 by ESI triage system were enrolled. These patients were divided randomly into three groups. The site of venipuncture was covered with 2 g of topical ketamine cream 10% in group one, 2 g of 5% EMLA cream in group two, and finally, in group 3 (control group), was covered with placebo (2 g of cold cream). The primary end point of the study was reported pain severity with secondary end points being onset of local anesthesia as well as any side effects noted.
Results
The data gathered showed pain score during venipuncture in both intervention groups were significantly lower when compared to the control group (P < 0.05). However, pain score did not differ between the 2 intervention groups (P = 0.395). There was no statistically significant difference between the ketamine or EMLA in onset of local anesthesia (P = 0.419). We noted itching and irritation was significantly higher in the EMLA group when compared to ketamine(P < 0.05).
Conclusion
This study showed that local cutaneous ketamine is as effective as EMLA in relieving pain during venipuncture.
