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Leg ulcer progression caused by topical anesthesia with EMLA ® cream
Author(s) -
Stahl Maren,
Meyer Cora,
Haas Ellen,
Glaenz Thomas,
Zutt Markus
Publication year - 2008
Publication title -
jddg: journal der deutschen dermatologischen gesellschaft
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 60
eISSN - 1610-0387
pISSN - 1610-0379
DOI - 10.1111/j.1610-0387.2007.06532.x
Subject(s) - medicine , prilocaine , lidocaine , necrosis , microcirculation , surgery , anesthesia , pathological , pathology , radiology
Summary While treating a 63‐year‐old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material.After topical anesthesia with a lidocaine‐prilocaine mixture (EMLA ® cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application.The area turned necrotic over days and the center was débrid‐ed. A more detailed history revealed that similar necrosis had occurred previously when EMLA ® cream had been employed.We interpreted the current event,as well as the past episodes,as a pathological reaction of the small cutaneous blood vessels to EMLA ® cream. The history also revealed an overlap connective tissue disease with microvascular impairment. After exposure to the topical anesthetics, the pre‐damaged cutaneous blood vessels presumably produced a critical ischemia with subsequent necrosis. Based on this case, we recommend careful use of EMLA ® cream with frequent monitoring for necrosis when treating patients with a known disorder of microcirculation.