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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34 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 for different age groups, body locations, and dermatologic procedures. Many studies have evaluated topical anesthesia in various populations for various indications. It is commonly held that most topical anesthetics are safe, but compounded products should be prescribed specifically for individual patients and should not be mass produced. Compounded products may not be standardized and may contain concentrations of active ingredients that are higher than FDA-approved products. There have been numerous clinical trials evaluating FDA-approved product use for topical anesthesia in dermatologic procedures, such as the lidocaine/tetracaine cream (Pliaglis ® , Galderma Laboratories, Fort Worth, Texas) and the lidocaine/prilocaine cream (EMLA ® cream; lidocaine 2.5% and prilocaine 2.5%; AstraZeneca Pharmaceuticals, Westborough, Massachusetts). 5 To the authors' knowledge, there have been no head-to-head clinical studies of compounded products and these FDA-approved products. These compound medications typically contain higher concentrations of anesthetics than those found in FDA-approved products, and the result of the study may be inconsistent due to the variation of the mixtures prepared in independent compounding pharmaicies. 14 Disruption of stratum corneum leads to enhancement of drug absorption and leads to faster onset of anesthesia. 15 Therefore, these patients can reach unpredictable high levels of anesthesia. Improper application of these compounded products, such as prolonged application or occlusion, use of inappropriately high concentrations, or use on an improper surface may cause serious complications, including o R i g i n a l R E s E a R C h T a b l e 2 . v i s u a l a n a l o g p a i n s c a l e r a t e d a t b a s e l i n e a n d a t fi r s t n e e d l e - s t i c k i n j e c t i o n B A S E l i N E F i R S T N E E D l E S T i C k p v A l u E viSuAl ANAlOGuE SCAlE S mooth type Mean±SD Median (Min–Max) 5.87±10.34 2 (0–48) 21.68±20.82 14 (1–81) <0.001 <0.001 Abrasive type Mean±SD Median (Min–Max) 5.65±10.29 2 (0–51) 20.52±23.29 9 (0–79) <0.001 <0.001 WONG-BAkER FACES PAiN RATiNG SCAlE Smooth type Mean±SD Median (Min–Max) 0.55±0.68 0 (0–3) 1.74±0.89 2 (0–4) <0.001 <0.001 Abrasive type Mean±SD Median (Min–Max) 0.52±0.72 0 (0–3) 1.45±0.93 1 (0–3) <0.001 <0.001 T a b l e 3 . C o m p a r a t i v e r e s u l t o f m e a n p a i n s c a l e b e t w e e n t w o g r o u p s o f B l T b y v A S a n d W o n g - B a k e r F a c e s P a i n R a t i n g S c a l e S M O O T H M E A N ± S D M E D i A N / ( M i N E M A x H A B R A S i v E M E A N ± S D M E D i A N / ( M i N E M A x H p v A l u E viSuAl ANAlOGuE SCAlE Baseline First needle stick End 5.87±10.34/2(0-48) 21.68±20.82/14(1-81) 9.48±18.77/2(0-92) 5.65±10.29/2(0-51) 20.52±23.29/9(0-79) 6.87±11.97/2(0-50) 0.499 0.786 0.400 WONGFBAkER FACES PAiN RATiNG SCAlE Baseline First needle stick End 0.55±0.68/0(0-3) 1.74±0.89/2(0-4) 0.77±1.06/0(0-4) 0.52±0.72/0(0-3) 1.45±0.93/1(0-3) 0.61±0.88/0(0-3) 0.572 0.231 0.344 Paired t-test; signiDcance (p<0.05)

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