Petechial eruption after the application of EMLA cream.

Abstract

* Abbreviation: EMLA = : eutectic mixture of local anesthetics The use of EMLA (eutectic mixture of local anesthetics) cream, especially in pediatrics and dermatology, has significantly reduced emotional and physical discomfort during typically uncomfortable procedures such as venipuncture, intravenous cannulation, lumbar puncture, curettage of molluscum contagiosum lesions, laser therapy of vascular birthmarks, skin biopsy, and cryosurgery of verrucae. EMLA cream is a mixture of lidocaine (25 mg/L) and prilocaine (25 mg/L), [an emulsifier], arlatone 289, [a thickener], carbopol 934, [sodium hydroxide] to adjust the pH to 9.4, and distilled water.1 For EMLA cream to act as an effective topical anesthetic, it must be applied to intact skin for at least 1 hour before the procedure and occluded with either Saran Wrap or Tegaderm.2 The duration of application of EMLA cream varies with the site of application and type of procedure performed.2 The amount of EMLA applied will depend on the surface area involved. Usually, 1 to 2 g of EMLA cream are applied per 10 cm2. Most patients tolerate the application of EMLA cream without adverse effects. The most common local effect is transient blanching of the skin,3 which is most often noted upon removal of the dressing and is caused by the active ingredients in EMLA cream.4 However, the mechanism of this effect is not clear. Erythema can also be observed after the application of EMLA cream.4 Villada et al4 found that erythema was noted most often 2 hours after application of EMLA cream. The erythema is usually asymptomatic and transient. Although the mechanism of the transient erythema is not understood, it seems to occur with greater frequency as the application time of EMLA cream increases.5There have been few reports of other cutaneous reactions including allergic contact dermatitis6 7 and urticaria.5Rarely, petechial or purpuric …