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Using Topical Anesthetics

History of Topical Anesthetics

drharveyabramsIt is known that early, sophisticated civilizations such as the Incas used a plant containing a substance they called “coca” in their religious ceremonies. In time they became aware of the plants anesthetic properties and cultivated it to use as both a numbing agent and as a stimulant. Coca’s active ingredient, cocaine, was isolated in 1860 and use effectively to perform eye surgery in 1884. The first laboratory made topical anesthetic, lidocaine, was introduced in 1943 which led to the development of other products also having the ability to decrease the sensation of pain.

Written by Harvey Abrams M.D. Reprinted by permission of ASDR. Los Angeles, CA

Classification of Topical Anesthetics

Topical anesthetics are broadly divided into two groups:
1. amides, and 2. esters.

To fully discuss the technical differences between the two groups is beyond the scope of this article. Suffice it to say that studies have consistently confirmed that amides are more effective in numbing the skin than esters. Amide and ester anesthetics tend to effectively numb mucous membranes such as the gums for dental procedures and the anal region for pain relief of hemorrhoids and other anal conditions.

— Written by Harvey Abrams M.D. Reprinted by permission of ASDR. Los Angeles, CA

Clinical Uses in Dermatology

There are numerous applications for using topical anesthetics for outpatient dermatologic procedures. Applying topical anesthetics to the skin 30-60 minutes before common dermatologic medical procedures such as skin biopsy, freezing pre-cancers with liquid nitrogen, lancing small cysts, and removing skin tags decreases the pain associated with those procedures.

Studies have shown that pre-treatment with topical anesthetics containing lidocaine ease the discomfort associated with aesthetic procedures. Dermal procedures such as tattoos, piercings, laser hair removal, laser tattoo removal, and facial resurfacing are all made more comfortable with topical anesthetic pre-treatment. Cosmetic injections of BOTOX, Juvederm, Restylane, and Radiesse, as well as, chemical peels are also made less painful by applying an anesthetic cream containing lidocaine 4% 30-60 minutes before treatment.

— Written by Harvey Abrams M.D. Reprinted by permission of ASDR. Los Angeles, CA


Over-the-counter topical anesthetics are considered to be safe when used as directed. Allergic skin reactions can occur and are usually caused by a product of the ester group of anesthetics such as benzocaine.

Using more than the recommended amount of anesthetic over a wide area of the skin can result in its absorption into the blood stream and lead to uncommon systemic reactions such as convulsions and heart irregularities.

Safety Tips and Recommendations

Use OTC numbing creams that are manufactured in the USA.
The manufacturing of OTC drugs in the USA must meet stringent inspection standards. Topical anesthetics manufactured in other countries are not guaranteed to meet standards of sterility, dosage calculation, and standardization of components.

Apply the topical anesthetic only on intact skin. Do not apply it after the skin has been repeatedly punctured by tattoo needles or after a severe burn. If a large area of the skin is to undergo treatment (laser hair removal of the entire back, or both legs, consult your doctor’s advice before applying. The application of ice packs or a cooling spray can be effective adjuncts to topical anesthesia and can be used during the procedure.

Use a topical anesthetic containing lidocaine. For numbing up the skin, the highest strength of lidocaine allowed in the U.S. is 4%. For use in the anal area, 5% lidocaine is allowed by the FDA. Topical anesthetics sold over-the-counter with higher concentrations of lidocaine should not be purchased or used.

— Written by Harvey Abrams M.D. Reprinted by permission of ASDR. Los Angeles, CA





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