title: Lidocaine iontophoresis versus EMLA cream for CO2 laser treatment in seborrheic keratosis.
abstract: BACKGROUND
  Topical anesthesia for skin surgery has widely been used for a long time. Various preparations are used. The EMLA cream is the most popular one.
  
  
  OBJECTIVE
  The authors compared the local analgesic effect of topical lidocaine iontophoresis and EMLA cream in a crossover study design.
  
  
  METHODS
  After informed consent, 16 patients with seborrheic keratosis, who required CO2 laser surgery, were enrolled. Two lesions on the opposite side of the body with a comparable size, shape and location were selected from each patient. The lidocaine iontophoresis was done on one lesion and the EMLA cream was applied on the other The CO2 laser surgery was performed after 10 min of lidocaine iontophoresis and 60 min after EMLA cream. The level of pain was recorded using a 100-mm visual analog scale. Ratings of patient satisfaction were also assessed.
  
  
  RESULTS
  There were no significant differences in pain scores between the two groups (p=0.968), but significantly higher in satisfaction scores (1-5 scale) in the iontophoretic group than the EMLA group (p=0.005). Fifteen patients preferred lidocaine iontophoresis (93.8%), none preferred EMLA cream. All patients in the present study tolerated the tingling and burning sensations. No severe adverse events and side effects were detected.
  
  
  CONCLUSIONS
  Lidocaine iontophoresis provides effective pain relief for CO2 laser surgery of seborrheic keratosis as well as the EMLA cream. The effect is as fast as 10 min after application. There is no significant side effect. Most of the patients were satisfied. Lidocaine iontophoresis is a useful, noninvasive local anesthesia for CO2 laser surgery of superficial skin lesions.
authors.affiliation: Division of Dermatology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
authors.forename: Rosaya
authors.initials: R
authors.lastname: Phahonthep
authors.forename: Wannasri
authors.initials: W
authors.lastname: Sindhuphak
authors.forename: Pin
authors.initials: P
authors.lastname: Sriprajittichai
mesh_terms: D000368:Aged; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D002245:Carbon Dioxide; D006801:Humans; D007478:Iontophoresis; D017492:Keratosis, Seborrheic / Q000628:therapy*; D053685:Laser Therapy; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011318:Prilocaine / Q000627:therapeutic use*
chemical_list: D019162:Anesthetics, Combined; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D002245:Carbon Dioxide; D008012:Lidocaine