Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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31 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 o R i g i n a l R E s E a R C h anesthetics than those found in the United States Food and Drug Administration (FDA)-approved products. 5,6 Although there are several studies regarding lidocaine- containing topical anesthetics, up to now, there are no known controlled studies that have directly compared the safety and efficacy of the compounded anesthetic formulation of BLT cream. 5 BLT is a specially compounded mixture of powdered forms of abrasive particles that are mixed together in an oil base. Clinicians routinely use two main types of BLT: a smooth type and a coarsely textured type caused by abrasive particles that have not dissolved completely in the compounded mixture. Some clinicians prefer the abrasive type because they feel that when it is rubbed into the skin, the particles cause the cream to penetrate the skin more thoroughly to provide greater anesthesia than the smoothly textured type of BLT. However, the coarse texture of the anesthetic can cause it to penetrate into delicate structures of the eye and cause serious mechanical or chemical irritation to the cornea. A case report has cited adverse events related to the use of BLT penetration into the eye and possible injury to the cornea. 7 To the authors' knowledge, there were no comparative studies of BLT compounds available in the literature. With this study, they speculate that although there may be no clinically statistical differences between the two types of BLT creams in terms of clinical efficacy, it may be safer to use BLT without abrasives to minimize the potential for side effects. OBJECTIVES The purpose of this study was to compare the use of BLT cream with abrasive particles (pharmacy A) and without abrasive particles (pharmacy B) (Figure 1) to see which type of cream is more effective in reducing discomfort during cosmetic dermatologic procedures, specifically procedures using hyaluronic acid (HA) injectables. The authors hypothesize that there may not be a significant difference between the two types of BLT creams in terms of clinical efficacy; however, the smooth type of BLT without abrasives could be the safer type to use in terms of causing less side effects, such as potential risk of ocular injuries. The efficacy of BLT topical anesthetic cream with and without abrasive particles was evaluated by using the difference in scores from the visual analogue scale (VAS) and Wong-Baker FACES Pain Rating Scales. METHODS The study was approved by the University of Pennsylvania institutional review board and was conducted as a single-site, double- blind, paired study. The objective of the study was to evaluate the efficacy of two types of BLT anesthetic creams which were composed of smooth and abrasive particles. All of the participants gave their written informed consent to the investigators before participating in the study. The result of the BLT cream was evaluated when applied for local anesthesia before injecting dermal fillers for augmentation of volume depletion/wrinkles. Figure 1. blT used in the study (left: abrasive; right: smooth)

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