Lasers in Medical Science

, Volume 33, Issue 3, pp 573–579 | Cite as

EMLA cream does not influence efficacy and pain reduction during pulsed-dye laser treatment of port-wine stain: a prospective side-by-side comparison

  • Wenxin Yu
  • Tianyou Wang
  • Jiafang Zhu
  • Yajing Qiu
  • Hui Chen
  • Yunbo Jin
  • Xi Yang
  • Xiaojie Hu
  • Lei Chang
  • Yijie Chen
  • Gang Ma
  • Xiaoxi Lin
Original Article
  • 89 Downloads

Abstract

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm2 radiant exposure, 0.45 ms pulse duration, 10 mm spot size, and cryogen spray cooling (40 ms cooling plus a 20 ms delay). A topical anesthetic (EMLA cream: 2.5% lidocaine and 2.5% prilocaine) and a placebo were applied to two respective testing areas on all patients prior to treatment. The visual analog scale (VAS) was used for pain assessment. Clinical therapeutic outcomes were evaluated by visual evaluation and with the use of a chromameter 2 months after 3PDL treatments. The average VAS scores were 3.15 ± 0.95 and 8 ± 0.57 for the EMLA cream site and the placebo site, respectively, at a significance level p < 0.001. The EMLA cream site and the placebo site had clearance or fading rates of 45.08 and 44.12%, respectively (p < 0.05). No serious side effects were reported. Patients reported a consistent decrease in pain during PDL treatment when the topical anesthetic EMLA cream was administered. Treatment of PWS by PDL with EMLA cream does not lead to a decrease in efficacy or an increase in side effects; instead, it significantly reduces pain during treatment. EMLA cream is a safe and effective local topical anesthetic for PWS treatment by PDL.

Keywords

Pulsed-dye laser Port-wine stain EMLA cream dose Pain reduction 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants of the study.

References

  1. 1.
    Lanigan SW, Taibjee SM (2004) Recent advances in laser treatment of port-wine stains. Br J Dermatol 151:527–533CrossRefPubMedGoogle Scholar
  2. 2.
    Nelson JS, Milner TE, Anvari B, Tanenbaum BS, Svaasand LO, Kimel S (1996) Dynamic epidermal cooling in conjunction with laser-induced photothermolysis of port wine stain blood vessels. Lasers Surg Med 19:224–229CrossRefPubMedGoogle Scholar
  3. 3.
    Yamauchi PS, Soriano TT, Lask G (2000) Treatment of port wine stains using the pulsed-dye laser at 585 nm with the dynamic cooling device. J Cutan Laser Ther 2:33–36CrossRefPubMedGoogle Scholar
  4. 4.
    Waldorf HA, Alster TS, McMillan K, Geronemus RG, Nelson JS (1996) Effect of dynamic cooling on 585-nm pulsed dye laser therapy of port wine stains. A prospective study. Br J Dermatol 134:475–480CrossRefGoogle Scholar
  5. 5.
    Rabinowitz LG, Esterly NB (1992) Anesthesia and/or sedation for pulsed dye laser therapy. Pediatr Dermatol 9:132–153CrossRefGoogle Scholar
  6. 6.
    Epstein RH, Halmi B, Lask GP (1995) Anesthesia for cutaneous laser therapy. Clin Dermatol 13:21–24CrossRefPubMedGoogle Scholar
  7. 7.
    Lener EV, Bucalo BD, Kist DA, Moy RL (1997) Topical anesthetic agents in dermatologic surgery. Dermatol Surg 23:673–683PubMedGoogle Scholar
  8. 8.
    Grevelink JM, White VR, Bonoan R, Denman WT (1997) Pulsed laser treatment in children and the use of anesthesia. J Am Acad Dermatol 37:75–81CrossRefPubMedGoogle Scholar
  9. 9.
    Hallen B, Olsson GL, Uppfeldt A (1984) Pain-free venepuncture. Effect of timing of application of local anaesthetic cream. Anaesthesia 39:969–972CrossRefPubMedGoogle Scholar
  10. 10.
    Kurien L, Kollberg H, Uppfeldt A (1985) Venepuncture pain can be reduced. J Trop Med Hyg 88:397–399PubMedGoogle Scholar
  11. 11.
    Moller C (1985) A lignocaine-prilocaine cream reduces venipuncture pain. Ups J Med Sci 90:293–298CrossRefPubMedGoogle Scholar
  12. 12.
    Maunuksela EL, Korpela R (1986) Double-blind evaluation of a lignocaine-prilocaine cream (EMLA) in children. Br J Anaesth 58:1242–1245CrossRefPubMedGoogle Scholar
  13. 13.
    Cooper CM, Gemsh SP, Hardwick M, Kay R (1987) EMLA cream reduces the pain of venepuncture in children. Eur J Anaesthesiol 4:441–448PubMedGoogle Scholar
  14. 14.
    Hopkins CS, Buckley CJ, Bush GH (1988) Pain-free injection in infants. Use of a lignocaine-prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1-5-year-old children. Anaesthesia 43:198–201CrossRefPubMedGoogle Scholar
  15. 15.
    Watson AR, Szymkin P, Morgan AG (1988) Topical anaesthesia for fistula cannulation in haemodialysis patients. Nephrol Dial Transplant 3:800–802PubMedGoogle Scholar
  16. 16.
    Timms MS, O'Malley S, Keith AO (1988) Experience with a new topical anaesthetic in otology. Clin Otolaryngol 13:485–490CrossRefPubMedGoogle Scholar
  17. 17.
    Whittet HB, Williams HO, Wright A (1988) An evaluation of topical anaesthesia for myringotomy. Clin Otolaryngol 13:481–484CrossRefPubMedGoogle Scholar
  18. 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 19:201–209CrossRefPubMedGoogle Scholar
  19. 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 82:458–462CrossRefPubMedGoogle Scholar
  20. 20.
    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 41:533–538CrossRefPubMedGoogle Scholar
  21. 21.
    Rosdahl I, Edmar B, Gisslen H, Nordin P, Lillieborg S (1988) Curettage of molluscum contagiosum in children: analgesia by topical application of a lidocaine/prilocaine cream (EMLA). Acta Derm Venerol 68:149–153PubMedGoogle Scholar
  22. 22.
    Hallen A, Ljunghall K, Wallin J (1987) Topical anaesthesia with local anaesthetic (lidocaineand prilocaine, EMLA) cream for cautery of genital warts. Genitourin Med 63:316–319PubMedPubMedCentralGoogle Scholar
  23. 23.
    Arendt-Nielsen L, Bjerring P (1988) Laser-induced pain for evaluation of local analgesia: a comparison of topical application (EMLA) and local injection (lidocaine). Anesth Analg 67:115–123CrossRefPubMedGoogle Scholar
  24. 24.
    Juhlin L, Hagglund G, Evers H (1989) Absorptionof lidocaineand prilocaine after application of a eutecticmixture of local anesthetics (EMLA) on normal and diseased skin. Acta Derm Venerol 69:18–22PubMedGoogle Scholar
  25. 25.
    Engberg G, Danielson K, Henneberg S, Nilsson A (1987) Plasma concentrations of prilocaineand lidocaineand methaemoglobin formation of infants after epicutaneous application of a 5% lidocaine-prilocaine (EMLA). Acta Anaesthesiol Scand 31:624–628CrossRefPubMedGoogle Scholar
  26. 26.
    Ashinoff R, Geronemus RG (1990) Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains. J Dermatol Surg Oncol 16:1008–1011CrossRefPubMedGoogle Scholar
  27. 27.
    Juhlin L, Hägglund G, Evers H (1989) Absorption of lidocaine and prilocaine after application of a eutectic mixture of local anesthetics (EMLA) on normal and diseased skin. Acta Derm Venereol 69:18–22PubMedGoogle Scholar
  28. 28.
    Ehrenstrom-Reiz GM, Reiz SL (1982) EMLA-a eutectic mixture of local anaesthetics for topical anaesthesia. Acta Anaesthesiol Scand 26:596–598CrossRefPubMedGoogle Scholar
  29. 29.
    Evers H, von Dardel O, Juhlin L, Ohlsén L, Vinnars E (1985) Dermal effects of composition based on the eutectic mixture of lignocaine and prilocaine (EMLA). Studies in volunteers. Br J Anaesth 57:997–1005CrossRefPubMedGoogle Scholar
  30. 30.
    Wilder-Smith E, Chow A (2003) Water immersion and EMLA cause similar digit skin wrinkling and vasoconstriction. Microvasc Res 66:68–72CrossRefPubMedGoogle Scholar
  31. 31.
    Häfner HM, Thomma SR, Eichner M, Steins A, Jünger M (2003) The influence of EMLA cream on cutaneous microcirculation. Clin Hemorheol Microcirc 28:121–128PubMedGoogle Scholar
  32. 32.
    Metzler-Wilson K, Wilson TE (2013) Topical anaesthesia does not affect cutaneous vasomotor or sudomotor responses in human skin. Auton Autacoid Pharmacol 33:25–33PubMedGoogle Scholar
  33. 33.
    Schreiber S, Ronfani L, Chiaffoni GP, Matarazzo L, Minute M, Panontin E, Poropat F, Germani C, Barbi E (2013) Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study. Eur J Pediatr 172:265–268CrossRefPubMedGoogle Scholar
  34. 34.
    Sherwood KA (1993) The use of topical anesthesia in removal of port-wine stains in children. J Pediatr 122:S36–S40CrossRefPubMedGoogle Scholar
  35. 35.
    Bjerring P, Andersen PH, Arendt-Nielsen L (1989) Vascular response of human skin after analgesia with EMLA cream. Br J Anaesth 63:655–660CrossRefPubMedGoogle Scholar
  36. 36.
    Yu W, Ma G, Qiu Y, Chen H, Jin Y, Yang X, Chang L, Wang T, Hu X, Li W, Lin X (2015) Prospective comparison treatment of 595-nm pulsed-dye lasers for virgin port-wine stain. Br J Dermatol 172:684–691CrossRefPubMedGoogle Scholar
  37. 37.
    Renfro L, Geronemus RG (1993) Anatomical differences of port-wine stains in response to treatment with the pulsed dye laser. Arch Dermatol 129:182–188CrossRefPubMedGoogle Scholar
  38. 38.
    Yu W, Ma G, Qiu Y, Chen H, Jin Y, Yang X, Hu X, Wang T, Chang L, Zhou H, Li W, Lin X (2016) Why do port-wine stains (PWS) on the lateral face respond better to pulsed dye laser (PDL) than those located on the central face? J Am Acad Dermatol 74:527–535CrossRefPubMedGoogle Scholar
  39. 39.
    Rah DK, Kim SC, Lee KH, Park BY, Kim DW (2001) Objective evaluation of treatment effects on port-wine stains using L*a*b* color coordinates. Plast Reconstr Surg 108:842–847CrossRefPubMedGoogle Scholar
  40. 40.
    Gao K, Huang Z, Yuan KH, Zhang B, Hu ZQ (2013) Side-by-side comparison of photodynamic therapy and pulsed-dye laser treatment of port-wine stain birthmarks. Br J Dermatol 168:1040–1046CrossRefPubMedGoogle Scholar
  41. 41.
    Tremaine AM, Armstrong J, Huang YC, Elkeeb L, Ortiz A, Harris R, Choi B, Kelly KM (2012) Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod. J Am Acad Dermatol 66:634–641CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Babilas P, Schreml S, Eames T, Hohenleutner U, Szeimies RM, Landthaler M (2010) Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains. Lasers Surg Med 42:720–727CrossRefPubMedGoogle Scholar
  43. 43.
    Núñez M, Miralles ES, Boixeda P, Gómez F, Pérez B, Abraira V, Ledo A (1997) Iontophoresis for anesthesia during pulsed dye laser treatment of port-wine stains. Pediatr Dermatol 14:397–400CrossRefPubMedGoogle Scholar
  44. 44.
    Huang N, Zeng J, Liang J, Qiu H, Wang Y, Gu Y (2014) A randomized, double-blind, placebo-controlled study of oral oxycodone plus acetaminophen for the treatment of pain in photodynamic therapy on port wine stains. Photodiagn Photodyn Ther 11:134–140CrossRefGoogle Scholar
  45. 45.
    Tan OT, Stafford TJ (1992) EMLA for laser treatment of port wine stainsin children. Lasers Surg Med 12:543–548CrossRefPubMedGoogle Scholar
  46. 46.
    Alster TS, Allen L (1993) Effectiveness of topical anesthesia for treatmentof port wine stains in children using the 585nm pulsed dye laser. Lasers Surg Med 5:68Google Scholar
  47. 47.
    Hernández E, González S, González 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 23:167–171CrossRefPubMedGoogle Scholar
  48. 48.
    Friedman PM, Fogelman JP, Nouri K, Levine VJ, Ashinoff R (1999) Comparative study of the efficacy of four topical anesthetics. Dermatol Surg 25:950–954CrossRefPubMedGoogle Scholar
  49. 49.
    Brodin AF, Nyquist FA, Wadsten T, Forslund B, Broberg F (1984) Phase diagram and aqueous solubility of the lidocaine-prilocaine binary system. J Pharm Sci 73:481CrossRefPubMedGoogle Scholar
  50. 50.
    Bryan HA, Alster TS (2002) The S-Caine peel: a novel topical anesthetic for cutaneous laser surgery. Dermatol Surg 28:999–1003PubMedGoogle Scholar
  51. 51.
    Lanigan S (2009) Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening. Lasers Med Sci 24:617–620CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2017

Authors and Affiliations

  • Wenxin Yu
    • 1
  • Tianyou Wang
    • 1
  • Jiafang Zhu
    • 1
  • Yajing Qiu
    • 1
  • Hui Chen
    • 1
  • Yunbo Jin
    • 1
  • Xi Yang
    • 1
  • Xiaojie Hu
    • 1
  • Lei Chang
    • 1
  • Yijie Chen
    • 1
  • Gang Ma
    • 1
  • Xiaoxi Lin
    • 1
    • 2
  1. 1.Department of Plastic and Reconstructive Surgery, Department of Laser and Aesthetic MedicineShanghai Jiaotong University, School of MedicineShanghaiChina
  2. 2.Plastic and Reconstructive SurgeryShanghai 9th People’s HospitalShanghaiChina

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