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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35 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 death. Difficulty may occur in dosing of these compounded products. 14 Kravitz reported that these compound products increased risk of AEs, such as overdose, because they have a low therapeutic index and may be improperly labeled. One of the most popular formulations of lidocaine-containing products used by cosmetic surgeons is BLT, which can cause serious AEs, including ocular injury. Because of their variation in texture, some dermatologists believe that the coarse texture with some abrasive particles would absorb better. 1 6 The authors' study does not prove that there is a statistically significant difference between the smooth and the abrasive type preparations. Allergic reactions are responsible for less than one percent of all adverse reactions to local anesthetics. Inciting allergens are composed of the anesthetic itself or their metabolic breakdown products or preservatives. Esters are more likely to cause allergic reactions due to the PABA metabolite. 17 Because the skin's keratinization acts as a major barrier to penetration of topical anesthetic, Berardesca et al proposed that ethnic differences in skin function may be responsible for skin reactivity in physiologic and pathologic conditions in terms of transcutaneous penetration and drug absorption. 18 As the authors found in their study, one participant who is Asian had a skin reaction to the abrasive type of BLT, which was not found in other participants who are Caucasian. However, localized edema, erythema, and blanching of the skin can be found in patients, which is considered to be due to pharmacological effects secondary to local vasodilatation. 19 A limitation of this study is patient reporting. Fear and anxiety may bias pain reporting and interfere with attempts at measuring pain intensity via the VAS score and Wong-Baker Faces Pain Rating scale. Proper explanation and physical demonstration could reduce these emotional effects. 20 In summary, the present study demonstrated that subjects experienced a higher mean pain level (but not statistically significant) when using the BLT with smooth texture compared to the BLT with abrasive particles when applied before HA dermal filler injection. These two types of anesthetic creams provided adequate pain management to patients. Allergic reaction was found in only one of 31 subjects (in an Asian patient), and it occurred on the side of the face where the abrasive BLT was used. Since application guidelines for using these types of compounded products are lacking, future studies are needed to develop compounded products as well as alternative methods to prevent patient discomfort during aesthetic injections. REFERENCES 1. American Society of Plastic Surgeons. 14.6 million cosmetic plastic surgery procedures performed in 2012: minimally invasive, facial rejuvenation procedure fuel 5% growth. 2013. http://www.plastic o R i g i n a l R E s E a R C h Figure 2. Erythema on the abrasive side of an asian participant who had skin type iii to iV

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