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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33 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 R E E both groups, they authors found no statistical difference in pain measurement between the two groups tested. They found that the mean VAS score was higher in the smooth base BLT cream. Likewise, the mean Wong-Baker Faces Pain Rating Scale is also higher in the smooth-based cream group. However, even though pain levels were higher at first needle stick injection in the smooth type cream on both VAS and the Wong-Baker Face Pain Rating Scale, the results were not statistically significant (P=0.786 and P= 0.231 respectively). All adverse events (AEs) were recorded during the procedures. The investigators found that both types of BLT were well-tolerated and safe. Participants had no erythema, edema, or signs of allergic contact dermatitis. However, the authors reported erythema on the abrasive side in an Asian patient who had skin type III to IV (Figure 2). DISCUSSION Topical anesthetics were developed in the latter half of the 19th century and have taken nearly a century to readily develop. 8 Today, pain can be effectively alleviated in many dermatologic procedures by using topical anesthetics. Even in some procedures, such as laceration repair, which at one time requires the use of painful infiltrative anesthetics, can now be accomplished comfortably with the use of topical anesthetics. 9 However, concerns regarding pain potential in patients are still a main issue in such procedures as soft tissue augmentation with dermal fillers. Interestingly, more than half of subjects were concerned about associated pain with cosmetic procedures. 10 This result suggests that patient comfort is an important consideration during aesthetic procedures, especially in procedures requiring the use of needle-based injections, such as injectable HA dermal fillers. Release of newer formulations of topical anesthetics with lidocaine may provide additional relief after the initial stick, but not the first needle-stick injection. 11 Several studies specifically have investigated mixing 2% lidocaine with HA prior to injection. 12 Recently, some research has been done about alternative methods of topical anesthesia when injecting dermal fillers, such as skin cooling through the use of cool air or ice. Ongoing research is devoted to developing effective topical anesthetics to minimize pain during injection of dermal fillers. 13 The ideal topical anesthetics should safely increase patient comfort with minimal AEs. Choosing the proper topical anesthetic must be individualized T a b l e 1 . P a t i e n t d e m o g r a p h i c s N = 3 1 % GENDER Female 28 90.32 Male 3 9.68 R ace Caucasian 29 93.55 Native American 1 3.23 Asian 1 3.23 Ethnicity Hispanic 1 3.23 Mix 7 22.58 Other 23 74.19 Age, yrs.; Mean±SD (Min–Max) = 54.35±11.89 (34–78)

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