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topical anesthetic creams Everyone wants less pain from local anesthetic shots. Many patients wonder why when they go to the dentist they can have something which reduces the pain of the shot but doctors don't rub something into the skin beforehand! The answer is that on the lining of the mouth topical anesthetics are absorbed and work well but on the skin they do not. Several types of topical anesthetic have been tried, including freezing the skin. This is done most easily by applying ice or spraying with a chemical which evaporates quickly. This then freezes the surface of the skin, an example of this is ethyl chloride. It is hard to numb a large areas with these methods and the effect is short lived. A more modern technique is a eutectic mixture of local anesthetic (EMLA) cream. This contains a mixture of anesthetics, commonly lidocaine (2.5%) and prilocaine (3.5%). The active ingredients enter the skin as small oil droplets. The cream must be applied at least two hours before surgery to have an effect. EMLA cream has been used in many areas of plastic surgery, including taking skin grafts, cleaning (debriding) skin ulcers and for chemical peels. It may also have a use in patients who have extreme fear of injections. Although significant amounts of local anesthetic are absorbed by the body it does not appear that this is dangerous. Even when applied to open wounds it does not appear to interfere with healing. When used for chemical peels however it may increase the depth of trichloroacetic acid peels and so a weaker peel may need to be used. The major disadvantage is the mess and inconvenience of applying the cream at least two hours before use. In addition the amount of anesthesia is variable and limited. In general topical anesthetics have a role but their general use has not been widely adopted because of the inconvenience

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