title: Systemic toxicity from topically applied lidocaine in conjunction with fractional photothermolysis.
abstract: BACKGROUND
  Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic and neurotoxic adverse events have been reported to occur.
  
  
  METHODS
  A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years' duration. Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30% lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity. The results of laboratory studies confirmed serum lidocaine levels within the toxic range. We postulate that the combination of the high concentration of topical lidocaine required to achieve sufficient anesthesia, together with the laser-induced disruption in epidermal barrier function, may have been responsible for this phenomenon.
  
  
  CONCLUSIONS
  Application of a 30% topical lidocaine gel to a limited area in conjunction with fractional photothermolysis may generate serum lidocaine levels high enough to elicit systemic toxicity. Laser surgeons should be alert to this phenomenon, particularly in patients with underlying hepatic, endocrine, cardiac, or central nervous system/psychiatric dysfunction; in patients with a low body mass index; and in patients who are taking medications that may interfere with hepatic lidocaine metabolism.
authors.affiliation: David Geffen School of Medicine, University of California-Los Angeles, 100 UCLA Medical Plaza, Los Angeles, CA 90024, USA.
authors.forename: Diego E
authors.initials: DE
authors.lastname: Marra
authors.forename: Darwin
authors.initials: D
authors.lastname: Yip
authors.forename: Edgar F
authors.initials: EF
authors.lastname: Fincher
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Moy
mesh_terms: D000279:Administration, Cutaneous; D000779:Anesthetics, Local / Q000009:adverse effects*; D003937:Diagnosis, Differential; D064420:Drug-Related Side Effects and Adverse Reactions / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology; D005148:Facial Dermatoses / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000473:pathology / Q000532:radiotherapy*; D008012:Lidocaine / Q000009:adverse effects*; D028022:Low-Level Light Therapy; D008875:Middle Aged
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine