Comparative Efficacy and Patient Preference of Topical Anaesthetics in Dermatological Laser Treatments and Skin Microneedling

BACKGROUND: Topical anaesthetics are effective for patients undergoing superficial dermatological and laser procedures. Our objective was to compare the efficacy and patient preference of three commonly used topical anaesthetics: (2.5% lidocaine/2.5% prilocaine cream (EMLA(®)), 4% tetracaine gel (Ametop™) and 4% liposomal lidocaine gel (LMX4(®))) in patients undergoing laser procedures and skin microneedling. SETTINGS AND DESIGN: This was a prospective, double-blind study of patients undergoing laser and skin microneedling procedures at a laser unit in a tertiary referral dermatology centre. MATERIALS AND METHODS: All 29 patients had three topical anaesthetics applied under occlusion for 1 hour prior to the procedure, at different treatment sites within the same anatomical zone. A self-assessment numerical pain rating scale was given to each patient to rate the pain during the procedure and each patient was asked to specify their preferred choice of topical anaesthetic at the end of the procedure. STATISTICAL ANALYSIS: Parametric data (mean pain scores and frequency of topical anaesthetic agent of choice) were compared using the paired samples t-test. A P-value of ≤0.05 was considered as statistically significant. RESULTS AND CONCLUSIONS: Patients reported a mean (±SD; 95% confidence interval) pain score of 5 (±2.58; 3.66-6.46) with Ametop™, 4.38 (±2.53; 2.64-4.89) with EMLA(®) and 3.91 (±1.95; 2.65-4.76) with LMX4(®). There was no statistically significant difference in pain scores between the different topical anaesthetics. The majority of patients preferred LMX4(®) as their choice of topical anaesthetic for dermatological laser and skin microneedling procedures.