Topical Anesthetic Use in Cosmetic Dermatology

Topical anesthetics are medications that are commonly used in medicine to obtain local anesthesia via topical application. They have a role in providing local anesthesia in cutaneous procedures, ocular procedures, and mucosal procedures, among other indications. There are multiple, well-written, and inclusive review articles detailing the history, categories, formulations, mechanisms of action, evidence for use and benefit, instructions for application, indications for use, and risks and safety of topical anesthetics.^1-5

For this paper, we focused on the role of topical anesthetics in cosmetic dermatology. Topical anesthetics provide multiple benefits in cosmetic dermatology. Their benefits include but are not limited to: decreasing the sensation of pain during a procedure, allowing local anesthesia to be achieved without anatomical distortion of the tissue, allowing local anesthesia to be achieved in some cases without needle infiltration, allowing procedures to be performed in an office setting, and minimizing the need for general anesthesia or sedation.¹

Dermatologists have an incentive to find the holy grail of topical anesthetics: a topical anesthetic that is safe when applied correctly, has a low-risk side effect profile, provides anesthesia in a timely manner, easy to acquire for both the patient and the provider, and not cost prohibitive. In our search for a topical anesthetic that meets these criteria, we developed a survey tool to send to other cosmetic dermatologists to learn from their experiences on the topic.

An anonymous 14 question survey was emailed to 101 dermatologists across the country who practice cosmetic dermatology. Surveys were emailed and answers were collected from December 2021 to February 2022. Two reminder emails were sent after the initial email inviting the dermatologists to participate. The survey included questions on the use of topical anesthetics. Survey participation was voluntary.

Survey Characteristics
The survey assessed topical anesthetic ingredients, for which procedures they are used, cost per gram, where they are purchased, how long they are applied before the procedure, use under occlusion or not, how they are supplied to the patients, and if there have ever been any adverse events associated with the use of topical anesthetics in the respondents’ practices.

Analysis
Descriptive statistics were used in analysis of survey results. Optional free text responses were included in the survey and organized into common responses.

Forty dermatologists responded to the survey. The majority of the respondents (39, or 97.5%) use topical anesthetics in their practice. Figure 1 lists the topical anesthetics used most often by the respondents. Figure 2 lists the procedures for which topical anesthetics are used in their practices. The cost per gram ranged