Pain Control for Hydrofluoric Acid Chemical Burn Using EMLA(R) Creams

PURPOSE: Although Hydrofluoric acid(HF) is not a strong acid compared to other hydrogen halides, it is a feared corrosive and is particularly dangerous in higher concentrations. HF burns are characterized by symptoms, often delayed and localized with diluted HF solutions, to include erythema, edema and severe pain. Pain, a well known symptom, is followed by exposure to calcium binding. And, EMLA(R) cream is a topical formulation based upon the eutectic mixture of lidocaine and prilocaine and is used in clinical settings to relieve pain undergoing superficial surgical procedures. The aim of this study is to evaluate effects of EMLA(R) cream, pain-control dressing on the treatment for HF injury wound. METHODS: From June 2007 to June 2008, this study was carried out with 10 patients who had HF partial thickness burns. We were applied topically EMLA(R) cream to injured wound with vaseline gauze and 10% calcium gluconate wet gauze dressings. As a principle, in the emergency treatment, partial or complete removal of the bullae along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. The effect of dressing was investigated by visual analogue pain scale. RESULTS: We therefore reviewed 10 cases of HF- induced pain and pain relief treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae and EMLA(R) related complications. CONCLUSION: Proper initial treatment of HF burn is important. If not promptly recognized or properly treated, it produces serious injury. Topical EMLA(R) cream remains a powerful, new advancement for minimizing HF-related pain during dressing procedures. When used appropriately, topical EMLA(R) cream can be a safe and effective alternative to other forms of HF-pain control treatment.

Efficacy of EMLA(R) for Pain Relief during PhotodynamicTherapy in the Treatment of Common Warts / 대한피부과학회지

BACKGROUND: Photodynamic therapy (PDT) in the treatment of warts is known to be a relatively effective and safe cure. However, the pain, which occurs during being exposed to a light source and after its exposure, is being reported to be the most frequent and serious limitation in this therapy. OBJECTIVE: The purpose of this study is to examine whether the level of pain can be lowered, by comparing EMLA(R), which is a topical anesthesia, with placebo, during topical ALA-PDT, and to try to compare the range and characteristics in pain. METHODS: Twenty two patients with common warts were treated with ALA-PDT twice in the interval of 4 weeks, and were divided into two groups by the random distribution table. The distribution was made so that the patients, who used EMLA(R) as the topical anesthesia given at the first visit, could use a placebo at the second visit, and so that the patients who used placebo at the first visit, could use EMLA(R) at the second visit. Thus, a randomized, double-blind, placebo-controlled crossover study was carried out. The pain was evaluated during the treatment, right after the treatment, and one day after the treatment by using Visual Analogue Scale (VAS). Also four different ranges of the pain and its six characteristics were evaluated. RESULTS: Of the 22 patients with common warts who underwent this study. 1 patient, was completely cured after the first visit, and did not participate further in the study. The data of the patients with complete recovery wasn't included in the final statistical analysis. As a result of the evaluation of pain, the mean VAS score that was measured during the treatment, right after the treatment, and one day after the treatment was measured to be a little lower in the case of applying EMLA(R) versus placebo, but a statistically significant difference was not observed. Regarding the degree of pain, regardless of applying EMLA(R), most patients felt painful locally on the surface, and the majority complained of burning and shooting pain. CONCLUSION: Dermatologists tend to routinely apply EMLA(R), prior to a procedure in order to decrease pain. However, as a result of this research, the routine use of EMLA(R) given at PDT is thought to be unreasonable.