Allergic contact dermatitis from EMLA cream: concomitant sensitization to both local anesthetics lidocaine and prilocaine

Abstract

Local anesthetics are widely used drugs. In contrast to the local anesthetics of the ester group, the ones of the amide group (for example prilocaine and lidocaine) are considered to be rare sensitizers. Positive patch test results to both prilocaine and lidocaine in EMLA cream might indicate potential cross-reactivity.

Mimickers of classic acantholytic diseases

“…EMLA ® (eutectic mixture of 2.5% lidocaine and prilocaine in oil and water; APP Pharmaceuticals, Shaumburg, IL, USA) is used as a topical anesthetic agent. Side‐effects are uncommon, though irritant, allergic and purpuric reactions have been reported . A recent case series identified three patients with vulvar lichen planus in whom EMLA ® was applied prior to performing a biopsy.…”

“…Side-effects are uncommon, though irritant, allergic and purpuric reactions have been reported. [43][44][45] A recent case series identified three patients with vulvar lichen planus in whom EMLA â was applied prior to performing a biopsy. Two of the patients' biopsies demonstrated acantholysis while the third showed full-thickness epidermal necrosis and congestion of papillary dermal vessels.…”

Guideline Implementation: Local Anesthesia

“…Allergic reactions to local anesthesia can occur within minutes of the injection or take as long as a month to appear 4,8,26 . Common manifestations of an allergic reaction to a local anesthetic agent include anxiety, bronchospasm, dizziness, erythema, edema, nausea, pruritus, rash, and urticaria 27‐33 …”

Acute bullous irritant contact dermatitis caused by EMLA® cream

“…Patch testing gave a negative result, but no prick or intradermal tests were performed. Allergic contact dermatitis related to prilocaine (1–3) or to both components (4) has been previously reported, as well as contact urticaria caused by lidocaine after EMLA ® cream application (5). In those cases, patch testing was useful to find the culprit component.…”

“…They include itching, burning, pain, pallor or blanching, erythema, oedema, and purpura. Allergic contact dermatitis related to prilocaine has been reported (1–5). Rarely, cases of irritant contact dermatitis after EMLA ® cream application have been described (6–8).…”