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Topical anaesthetic effects on skin vasculature with potential implications for laser treatment

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Abstract

Laser treatment of vascular lesions is affected by parameters including the diameter and depth of the vessels and flow within the vessels. Topical anaesthetics are in common use prior to laser treatment but may have effects on vessel parameters and, subsequently, the efficacy of laser treatment. Eleven patients with capillary vascular malformations were investigated for vessel diameter before and after elective application of a topical anaesthetic, Eutectic Mixture of Local Anaesthetics (EMLA) (AstraZeneca) or Ametop (S&N Health), prior to pulsed dye laser treatment. EMLA contains 2.5 % lidocaine ad 2.5 % prilocaine, and Ametop gel contains 4 % tetracaine. Patients’ capillary malformations were assessed using confocal laser scanning microscopy (CLSM) (Vivascope 1500 Mavig GmbH, Munich). Six of the 11 patients recruited had EMLA topical anaesthetic, and five had Ametop. Four hundred twenty-one diameters were measured. The mean vessel diameter was 50.87 μm. Previous laser treatments undergone by each patient were noted to exclude this as a confounding variable, and no significant difference was found between topical anaesthetic groups. Statistical calculations were made using GenStat and Minitab. There is no evidence that Ametop affects mean diameter (p value is 0.361). EMLA reduces the mean diameter of vessels (p = 0.002), with a 27 % reduction in post-EMLA diameter. This study demonstrates that the use of EMLA cream has a statistically significant reduction vessel diameter. As it is known that vessel diameter is important for the response of laser treatment, the use of EMLA may affect outcome.

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References

  1. Goldman MP, Fitzpatrick RE, Ruiz-Esparza J (1993) Treatment of port-wine stains (capillary malformation) with the flashlamp-pumped pulsed dye laser. J Pediatr 122(1):71–77

    Article  CAS  PubMed  Google Scholar 

  2. Lanigan SW (1998) Port-wine stains unresponsive to pulsed dye laser: explanations and solutions. [Review] [39 refs]. Br J Dermatol 139(2):173–177

    Article  CAS  PubMed  Google Scholar 

  3. Eubanks LE, McBurney EI (2001) Videomicroscopy of port-wine stains: correlation of location and depth of lesion. J Am Acad Dermatol 44(6):948–951

    Article  CAS  PubMed  Google Scholar 

  4. Sivarajan V, Mackay IR (2005) Noninvasive in vivo assessment of vessel characteristics in capillary vascular malformations exposed to five pulsed dye laser treatments. Plast Reconstr Surg 115(5):1245–1252

    Article  CAS  PubMed  Google Scholar 

  5. Fiskerstrand EJ, Svaasand LO, Kopstad G, Ryggen K, Aase S (1996) Photothermally induced vessel-wall necrosis after pulsed dye laser treatment: lack of response in port-wine stains with small sized or deeply located vessels. J Investig Dermatol 107(5):671–675

    Article  CAS  PubMed  Google Scholar 

  6. Garden JM, Tan OT, Kerschmann R, Boll J, Furumoto H, Anderson RR et al (1986) Effect of dye laser pulse duration on selective cutaneous vascular injury. J Invest Dermatol 87(5):653–657

    Article  CAS  PubMed  Google Scholar 

  7. Waner M (2003) Recent developments in lasers and the treatment of birthmarks. Arch Dis Child 88(5):372–374

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Tan OT, Motemedi M, Welch AJ, Kurban AK (1988) Spotsize effects on guinea pig skin following pulsed irradiation. J Investig Dermatol 90(6):877–881

    Article  CAS  PubMed  Google Scholar 

  9. Kauvar AN, Geronemus RG (1995) Repetitive pulsed dye laser treatments improve persistent port-wine stains. Dermatol Surg 21(6):515–521

    Article  CAS  PubMed  Google Scholar 

  10. Aguilar G, Svaasand LO, Nelson JS (2005) Effects of hypobaric pressure on human skin: feasibility study for port wine stain laser therapy (part I). Lasers Surg Med 36(2):124–129

    Article  PubMed  Google Scholar 

  11. Nelson JS, Milner TE, Anvari B, Tanenbaum BS, Kimel S, Svaasand LO et al (1995) Dynamic epidermal cooling during pulsed laser treatment of port-wine stain. A new methodology with preliminary clinical evaluation. Arch Dermatol 131(6):695–700

    Article  CAS  PubMed  Google Scholar 

  12. Svaasand LO, Aguilar G, Viator JA, Randeberg LL, Kimel S, Nelson JS (2004) Increase of dermal blood volume fraction reduces the threshold for laser-induced purpura: implications for port wine stain laser treatment. Lasers Surg Med 34(2):182–188

    Article  PubMed  Google Scholar 

  13. Franco W, Childers M, Nelson JS, Aguilar G (2007) Laser surgery of port wine stains using local vacuum [corrected] pressure: changes in calculated energy deposition (Part II). Lasers Surg Med 39(2):118–127

    Article  PubMed  Google Scholar 

  14. McGill DJ, Mackay IR (2006) The effect of ambient temperature on capillary vascular malformations. Br J Dermatol 154(5):896–903

    Article  CAS  PubMed  Google Scholar 

  15. Friedman PM, Mafong EA, Friedman ES, Geronemus RG (2001) Topical anesthetics update: EMLA and beyond. Dermatol Surg 27(12):1019–1026

    CAS  PubMed  Google Scholar 

  16. Hernandez E, Gonzalez S, Gonzalez E (1998) Evaluation of topical anesthetics by laser-induced sensation: comparison of EMLA 5% cream and 40% lidocaine in an acid mantle ointment. Lasers Surg Med 23(3):167–171

    Article  CAS  PubMed  Google Scholar 

  17. Lawson RA, Smart NG, Gudgeon AC, Morton NS (1995) Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children. Br J Anaesth 75(3):282–285

    Article  CAS  PubMed  Google Scholar 

  18. Ohlsen L, Englesson S, Evers H (1985) An anaesthetic lidocaine/prilocaine cream (EMLA) for epicutaneous application tested for cutting split skin grafts. Scand J Plast Reconstr Surg 19(2):201–209

    Article  CAS  PubMed  Google Scholar 

  19. Lahteenmaki T, Lillieborg S, Ohlsen L, Olenius M, Strombeck JO (1988) Topical analgesia for the cutting of split-skin grafts: a multicenter comparison of two doses of a lidocaine/prilocaine cream. Plast Reconstr Surg 82(3):458–462

    Article  CAS  PubMed  Google Scholar 

  20. Taddio A, Gurguis MG, Koren G (2002) Lidocaine-prilocaine cream versus tetracaine gel for procedural pain in children. [Review] [22 refs]. Ann Pharmacother 36(4):687–692

    Article  CAS  PubMed  Google Scholar 

  21. Sivarajan V, Mackay IR (2004) The depth measuring videomicroscope (DMV): a non-invasive tool for the assessment of capillary vascular malformations. Lasers Surg Med 34(2):193–197

    Article  PubMed  Google Scholar 

  22. Sivarajan V, Maclaren WM, Mackay IR (2006) The effect of varying pulse duration, wavelength, spot size, and fluence on the response of previously treated capillary vascular malformations to pulsed-dye laser treatment. Ann Plast Surg 57(1):25–32

    Article  CAS  PubMed  Google Scholar 

  23. Sivarajan V, Smith G, Mackay IR (2007) The validation of the depth measurement videomicroscope (DMV) as a noninvasive tool for the assessment of capillary vascular malformations. JPRAS 60(1):79–86

    PubMed  Google Scholar 

  24. Biro P, Meier T, Cummins AS (1997) Comparison of topical anaesthesia methods for venous cannulation in adults. Eur J Pain 1(1):37–42

    Article  CAS  PubMed  Google Scholar 

  25. Friedman PM, Fogelman JP, Nouri K, Levine VJ, Ashinoff R (1999) Comparative study of the efficacy of four topical anesthetics. Dermatol Surg 25(12):950–954

    Article  CAS  PubMed  Google Scholar 

  26. Doshi SN, Friedman PM, Marquez DK, Goldberg LH (2003) Thirty-minute application of the S-Caine peel prior to nonablative laser treatment. Dermatol Surg 29(10):1008–1011

    PubMed  Google Scholar 

  27. Alster TS, Lupton JR (2002) Evaluation of a novel topical anesthetic agent for cutaneous laser resurfacing: a randomized comparison study. Dermatol Surg 28(11):1004–1006, discussion 1006

    PubMed  Google Scholar 

  28. Ramos-Zabala A, Perez-Mencia MT, Fernandez-Garcia R, Cascales-Nunez MR (2004) Anesthesia technique for outpatient facial laser resurfacing. Lasers Surg Med 34(3):269–272

    Article  PubMed  Google Scholar 

  29. Goodacre TE, Sanders R, Watts DA, Stoker M (1988) Split skin grafting using topical local anaesthesia (EMLA): a comparison with infiltrated anaesthesia. Br J Plast Surg 41(5):533–538

    Article  CAS  PubMed  Google Scholar 

  30. Kilmer SL, Chotzen V, Zelickson BD, McClaren M, Silva S, Calkin J et al (2003) Full-face laser resurfacing using a supplemented topical anesthesia protocol. Arch Dermatol 139(10):1279–1283

    Article  PubMed  Google Scholar 

  31. Kaweski S (2008) Topical anesthetic creams. Plast Reconstr Surg 121(6):2161–2165

    Article  CAS  PubMed  Google Scholar 

  32. Arildsson M, Asker CL, Salerud EG, Stromberg T (2000) Skin capillary appearance and skin microvascular perfusion due to topical application of analgesia cream. Microvasc Res 59(1):14–23

    Article  CAS  PubMed  Google Scholar 

  33. Bjerring P, Andersen PH, Arendt-Nielsen L (1989) Vascular response of human skin after analgesia with EMLA cream. Br J Anaesth 63(6):655–660

    Article  CAS  PubMed  Google Scholar 

  34. Wiles MD, Dickson E, Moppett IK (2008) Transient hyperaemic response to assess vascular reactivity of skin: effect of topical anaesthesia. Br J Anaesth 101(3):320–323

    Article  CAS  PubMed  Google Scholar 

  35. Aps C, Reynolds F (1976) The effect of concentration on vasoactivity of bupivacaine and lignocaine. Br J Anaesth 48(12):1171–1174

    Article  CAS  PubMed  Google Scholar 

  36. Reynolds F, Bryson TH, Nicholas AD (1976) Intradermal study of a new local anaesthetic agent aptocaine. Br J Anaesth 48(4):347–354

    Article  CAS  PubMed  Google Scholar 

  37. Haggblad E, Larsson M, Arildsson M, Stromberg T, Salerud EG (2001) Reflection spectroscopy of analgesized skin. Microvasc Res 62(3):392–400

    Article  CAS  PubMed  Google Scholar 

  38. Berghoff M, Kathpal M, Kilo S, Hilz MJ, Freeman R (2002) Vascular and neural mechanisms of ACh-mediated vasodilation in the forearm cutaneous microcirculation. J Appl Physiol 92(2):780–788

    Article  CAS  PubMed  Google Scholar 

  39. Caselli A, Uccioli L, Khaodhiar L, Veves A (2003) Local anesthesia reduces the maximal skin vasodilation during iontophoresis of sodium nitroprusside and heating. Microvasc Res 66(2):134–139

    Article  CAS  PubMed  Google Scholar 

  40. Hsieh CH, Huang KF, Liliang PC, Huang PC, Shih HM, Rau CS (2007) EMLA and water immersion cause similar vasodilatation in replanted fingers. J Surg Res 143(2):265–269

    Article  PubMed  Google Scholar 

  41. Wiles MD, Dobson SA, Moppett IK (2010) The effect of a new topical local anaesthetic delivery system on forearm skin blood flow reactivity. Anaesthesia 65(2):178–183

    Article  CAS  PubMed  Google Scholar 

  42. Tahir A, Webb JB, Allen G, Nancarrow JD (2006) The effect of local anaesthetic cream (EMLA) applied with an occlusive dressing on skin thickness. Does it matter? J Plast Reconstr Aesthet Surg 59(4):404–408

    Article  CAS  PubMed  Google Scholar 

  43. Anderson RR, Parrish JA (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220(4596):524–527

    Article  CAS  PubMed  Google Scholar 

  44. McGill DJ, Mackay IR (2007) Capillary vascular malformation response to increased ambient temperature is dependent upon anatomical location. Ann Plast Surg 58(2):193–199

    Article  CAS  PubMed  Google Scholar 

  45. Arildsson M, Nilsson GE, Stromberg T (2000) Effects on skin blood flow by provocation during local analgesia. Microvasc Res 59(1):122–130

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, G4 OSF, UK

    Clare Josephine Tollan & Iain R. Mackay

  2. Department of Statistics, Department of Statistics, Glasgow Caledonian University, Glasgow, G4 OBA, UK

    William MacLaren

Authors
  1. Clare Josephine Tollan
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  2. William MacLaren
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  3. Iain R. Mackay
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Correspondence to Clare Josephine Tollan.

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Tollan, C.J., MacLaren, W. & Mackay, I.R. Topical anaesthetic effects on skin vasculature with potential implications for laser treatment. Lasers Med Sci 31, 611–617 (2016). https://doi.org/10.1007/s10103-016-1872-4

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  • DOI: https://doi.org/10.1007/s10103-016-1872-4

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