Topical AnaestheticTopical Anaesthetic*

Successful pain management is a significant factor in reducing patient anxiety and providing successful treatment outcomes. If pain is managed well, it can enhance patient satisfaction and reduce post-treatment complications.

Topical anesthesia is defined as superficial loss of sensation in conjunctiva, mucous membranes, or skin, produced by direct application of local anesthetic solutions, ointments, gels or sprays.

Being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic practice. They cause superficial loss of pain sensation after direct application.

The most widely used and available at aesthetic pharmacies are Elma, LMX and Pliaglis.

In Microneedling, we tend to use it for almost every treatment and particularly and more commonly on the more sensitive areas of the face such as the boney, thin skin area of the forehead and commonly sensitive top lip and during training I advise the least to be used the safest as risk of adverse events with improper application of this ‘over the counter’ pharmacy (P) drug is very real, practitioners must exercise caution and good judgment while using topical anaesthetics.

While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects including:

Burning or stinging at the administration site.

Systemic toxicity-due to excess dosage, repeated use, particularly in patients on risk like infants or children or elderly, or patients with liver disease etc.

Manifestations of adverse effects can be as follows:

Nonspecific-metallic taste, circumoral numbness, diplopia, tinnitus, dizziness.

High plasma concentration can produce CNS excitation (agitation, confusion, muscle twitching, seizure), or CNS depression (drowsiness, obtundation, coma or respiratory arrest).

Solutions that contain epinephrine may add to the CNS stimulatory effect.

Cardiovascular: Hypertension, tachycardia, ventricular arrhythmias (ventricular tachycardia, torsades de pointes, ventricular fibrillation, or progressive hypotension, conduction block, bradycardia or asystole. Local anesthetics that contain epinephrine may cause hypertension, tachycardia, and angina.

Allergic reaction

Gag-reflex suppression may occur with oral administration.


Skin discoloration, swelling, neuritis and in rare cases, tissue necrosis!


Ester group topical anesthetics are contraindicated in patients with known allergy to PABA, sulfonamides and hair dyes.

Standardisation of compounded topical anaesthetic products proves difficult because of the differing protocols and mix of ingredients used by individual pharmacies, making accurate dosing complicated.

Practitioners need to be aware of these risks as what looks like just a harmless cream or gel in a tube, can actually be extremely risky when used without taking proper assessment of the patient and using with extreme caution.

Worryingly there are also products on the open market with similar ingredients like ‘Dr Numb’ and ‘Lidoxin’ and I would advise to purchase products from reputable pharmacies only.


*If references or further reading on this is of interest, please email