Journal of Clinical and Aesthetic Dermatology

OCT 2017

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

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26 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY October 2017 • Volume 10 • Number 10 O R I G I N A L R E S E A R C H I In the United Kingdom (UK), penile biopsy is a procedure commonly performed by dermatologists and venereologists to aid in the diagnosis of male genital skin disorders. The safety of epinephrine use at this site remains controversial due to concerns about the blood supply to the penis, which is traditionally considered to be formed of terminal vessels without collateral supply. 1 Epinephrine aims to provide benefit by constricting local vasculature to prolong anesthetic duration and reduce potential for bleeding. A limited evidence base on the safety of epinephrine injections in the penis has led to most historical literature advising against its use in this area of the body. 2,3 Despite this, it remains unclear how many physicians still use it as part of routine practice when performing penile biopsies and how often complications are observed. To provide further insight, we undertook a survey of UK dermatologists and sexual health physicians to assess variation in procedure technique and to determine the frequency of observed complications when using epinephrine in penile biopsy procedures. DESIGN A series of questions were devised using SurveyMonkey TM looking at variations in penile biopsy technique, use of epinephrine during this procedure, and observed complications. This was distributed to members of the British Association of Dermatologists (BAD) and the British Association for Sexual Health and HIV (human immunodeficiency virus) (BASHH) in December 2016. Statistical analysis was performed using SPSS version 20.0 (IBM Corp., Armonk, New York, United States). Chi-square was used to determine significance for categorical variables, with significance taken as less than 0.05. RESULTS Sixty-six responses were received from 46 dermatologists and 20 venereologists. Of the responders, 77.3 percent were consultants, 13.6 percent were registrars/residents, and 9.1 percent were specialty doctors. The response rates from BAD and BASHH were 4.4 percent (1,045 members) and 2.0 percent (1,004 members), respectively. Penile biopsies were performed monthly by 22.7 percent of responders, every six months by 43.9 percent, yearly by 22.7, and less frequently than yearly by 7.6 percent. Of the responders, 48.5 percent used topical anesthesia compared to 51.5 percent that did not use topical anesthesia. Use of topical anesthesia was more common among venereologists compared to dermatologists (75.0% vs.34.1%, p=0.004). The most common local anesthesia (LA) was 1% lignocaine (69.7%) followed by lignocaine 2% (30.3%), with both used in similar ratios by both specialties. Additionally, 36.4 percent of the responders routinely used A B S T R A C T OBJECTIVE: To determine frequency of use and safety of epinephrine containing local anesthesia among dermatologists in the United Kingdom and venereologists undertaking penile biopsy. DESIGN: A survey was distributed nationally to members of the British Association of Dermatologists and the British Association for Sexual Health and Human Immunodeficiency Virus in December 2016. RESULTS: Sixty-six responses were received: 36.4 percent of respondents used epinephrine routinely, 16.7 percent sometimes used it, and 47 percent did not use it at all. Epinephrine use was more commonly by dermatologists in either some or all cases (56.8%) compared with venereologists (40%). Only two complications were reported to epinephrine use. Both were temporary without report of necrosis. CONCLUSION: Use of epinephrine-containing local anesthesia is common among physicians in the United Kingdom undertaking penile biopsies. Despite this, no episodes of necrosis were observed. While further investigation is still required, it is likely that use of epinephrine-containing local anesthesia is safe for local penile injection. KEYWORDS: Epinephrine, adrenaline, local anesthesia, penile biopsy, punch biopsy Survey of Dermatologists and Venereologists Shows Varying Approach to Penile Biopsies by AARON WERNHAM, MBChB, and TANG NGEE SHIM, MD Drs. Wernham and Shim are from the University Hospitals Coventry and Warwickshire NHS Foundation Trust in Coventry, United Kingdom. J Clin Aesthet Dermatol. 2017;10(10):26–27 FUNDING: No funding was received. DISCLOSURES: The authors have no financial conflicts relevant to the content of this article. CORRESONDENCE: Aaron Wernham, MBChB; Email:

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