Comparison of lidocaine/tetracaine cream and lidocaine/prilocaine cream for local anaesthesia during laser treatment of acne keloidalis nuchae and tattoo removal: results of two randomized controlled trials. (10th December 2016)

• Record Type: Journal Article
• Authors: Greveling, K.; Prens, E.P.; ten Bosch, N.; van Doorn, M. B.
• Is Part Of: British journal of dermatology. Volume 176:Number 1(2017)
• Page Start: 81
• Page End: 86
• Publication Date: 2016-12-10
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.14848
• Languages: English
• ISSNs: 0007-0963

Abstract

Abstract : What's already known about this topic? Pain is a common adverse effect during dermatological laser procedures, which can be alleviated using a topical anaesthetic cream. What does this study add? Lidocaine/tetracaine self‐occlusive cream was not superior to lidocaine/prilocaine cream under plastic occlusion in reducing self‐reported pain during laser treatment of acne keloidalis nuchae and tattoo removal. Lidocaine/prilocaine cream under occlusion is the preferred topical anaesthetic during laser procedures when targeting dermal chromophores. Summary: Background: Pain is a common adverse effect of dermatological laser procedures. Currently, no standard topical anaesthetic cream exists for deeper dermal laser procedures. Objectives: To compare the efficacy of lidocaine/tetracaine cream and lidocaine/prilocaine cream in reducing self‐reported pain during deeper dermal laser treatment of acne keloidalis nuchae (AKN) and tattoos. Methods: We conducted two randomized, double‐blind, controlled clinical trials with intrapatient, split‐lesion designs: study A included patients with AKN ( n = 15); study B included patients with black tattoos ( n = 15). The primary end point was the patients' self‐reported pain on a 10‐cm visual analogue scale (VAS). Secondary objectives were the percentage of patients with adequate pain relief, willingness to pay €25 for the cream that provided the best pain relief and safety of the creams. Results: In both studies, VAS scores were lower for lidocaine/prilocaine cream, with a mean VAS difference in study A of 1·9 [95% confidence interval (CI) 1·0–2·8] and in study B of 0·6 (95% CI −0·7 to 1·9). In study A, adequate pain relief was achieved in 13% ( n = 2) with lidocaine/tetracaine cream vs. 73% ( n = 11) with lidocaine/prilocaine cream ( P = 0·004), and in study B in 53% ( n = 8) vs. 80% ( n = 12), respectively ( P = 0·289). In study A, 47% ( n = 7) were willing to pay an additional €25 vs. 73% ( n = 11) in study B. No serious adverse events occurred. Conclusions: Lidocaine/prilocaine cream under plastic occlusion is the preferred topical anaesthetic during painful laser procedures targeting dermal chromophores.