title: A clinical comparison of topical piroxicam and EMLA cream for pain relief and inflammation in laser hair removal Topical Anesthesia for Laser Hair Removal: Comparison of Spot Sizes and 755 nm versus 800 nm Wavelengths Evaluation of different temperatures in cold air cooling with pulsed-dye laser treatment of facial telangiectasia. Preliminary study of fine changes in the duration of dynamic cooling during 755-nm laser hair removal on pain and epidermal damage in patients with skin types III-V. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials A comparison of pain rating scales by sampling from clinical trial data. Evaluation of a Novel Topical Anesthetic Agent for Cutaneous Laser Resurfacing: A Randomized Comparison Study Reduction of pain and side effects in the treatment of solar lentigines with pneumatic skin flattening (PSF) Clinically important changes in acute pain outcome measures: a validation study. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Iontophoresis of lidocaine for anesthesia during pulsed dye laser treatment of port-wine stains. 60-minute application of S-Caine Peel prior to 1,064 nm long-pulsed Nd:YAG laser treatment of leg veins. The Effect of Cold Air Cooling on 585 nm Pulsed Dye Laser Treatment of Port‐Wine Stains Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial. Local anesthesia of the genital mucosa with a lidocaine/prilocaine cream (EMLA) for laser treatment of condylomata acuminata: a placebo-controlled study. Effect of percutaneous local anaesthetics on pain reduction during pulse dye laser treatment of portwine stains. Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic. Iontophoresis for anesthesia during pulsed dye laser treatment of port-wine stains. Effect of piroxicam gel for pain control and inflammation in Nd:YAG 1064-nm laser hair removal. Thirty‐Minute Application of the S‐Caine Peel Prior to Nonablative Laser Treatment Direct Comparison of EMLA versus Lidocaine for Pain Control in Nd: YAG 1,064 nm Laser Hair Removal Treatment of leg telangiectasia by using a long-pulse dye laser at 595 nm with and without dynamic cooling device. Cooling gel improves pulsed KTP laser treatment of facial telangiectasia. Two Randomized, Double‐Blind, Placebo‐Controlled Studies Evaluating the S‐Caine Peel for Induction of Local Anesthesia Before Long‐Pulsed Nd: YAG Laser Therapy for Leg Veins Evaluation of the S‐Caine Peel for Induction of Local Anesthesia for Laser‐Assisted Tattoo Removal: Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Study
abstract: The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium : yttrium – aluminum – garnet ( Nd : YAG ) 1,064 nm laser hair removal in female volunteers . Fifty female volunteers were enrolled in this prospect i ve , r and omized , double-blind , clinical study over a 6-month period . Patients were r and omly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA . Topical analgesics were applied to the treatment sites for 60 min . The pain scores [ on a visual analog scale ( VAS ) ] and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and 1 h , 2 h and 24 h after the hair removal . Patients ’ characteristics and the treatment setting s of the Nd : YAG 1,064 nm laser were similar in the two groups . The pain scores ( VAS ) were similar , and satisfaction was high in both groups after the hair removal . The number of blanching and erythema episodes were significantly higher in group E than in group P ( P < 0.001 ) . Inflammatory side effects were less frequent in group P than in group E after the procedure ( P < 0.001 ) . This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd : YAG 1,064 nm laser hair removal in female volunteers . Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream , because of its anti-inflammatory effect after the procedure Background . The C and ela alex and rite and the Coherent diode laser systems come equipped with built‐in skin cooling systems that are design ed to both protect the epidermis , allowing higher fluences , and to alleviate discomfort . Nevertheless , pain can be a significant problem especially with treatment of larger areas . Scatter of the laser beam is reportedly affected by the spot size . It is cl aim ed that larger spot sizes are more effective at identical fluences . Objective . This study evaluated the effectiveness of a topical 5 % lidocaine cream ( ELA‐Max ) to control pain and compared pain levels at identical fluences between the 8 mm and 12 mm spot size of the alex and rite laser and between the alex and rite and diode laser with its 9 mm spot size . Methods . The study was conducted in the axillae of 12 patients . Each axilla was divided in half for side‐by‐side comparison . Half of the right axilla was treated with the alex and rite 8 mm and the other half with the 12 mm spot size at identical fluences . The left axilla was treated at the maximum tolerated fluences with the alex and rite 12 mm spot size and the diode 9 mm spot size . Results . At identical fluences and other parameters , there was significantly more pain with the alex and rite 12 mm spot size than with the alex and rite 8 mm spot size , both with or without topical anesthesia . The alex and rite laser was significantly less painful than the diode laser both with and without topical anesthetic . The difference was most noticeable between the alex and rite 8 mm spot size and the diode 9 mm spot size . Topical 5 % lidocaine anesthesia was effective in reducing pain , though not completely , for both the alex and rite and the diode lasers . Conclusion . Topical 5 % lidocaine cream is a simple and effective method for reducing patient discomfort during laser hair removal procedures , even when a skin cooling device is being used . A larger spot size causes more pain than a smaller spot size at identical fluences . The 800 nm diode laser causes greater discomfort than the 755 nm alex and rite laser BACKGROUND AND OBJECTIVES Cold air cooling is widely used in dermatological laser therapy . We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia . STUDY DESIGN / MATERIAL S AND METHODS From September 2002 to February 2003 , 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser  ( 3.5 J/cm(2 ) , 585 nm , 0.45 milliseconds pulse length , 10 mm beam diameter , Cynosure V ) . The treatment area was divided into three sub- areas : no cooling , cold air cooling to 20 degrees C and to 17 degrees C skin temperature . The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream ( Cryo5 ) . In a prospect i ve study , we collected data on purpura , pain , clearance , and patient satisfaction on numerical analog scales ( NAS ) from 0 ( meaning " no " ) to 3 ( meaning " high " ) . RESULTS Without cooling , purpura ( 2.53 ) , pain ( 2.41 ) , and clearance ( 2.35 ) were rated medium to high . Cooling to 20 degrees C reduced purpura ( 1.12 ) and pain ( 1.06 ) , whereas the clearance ( 2.12 ) was only slightly affected . Cooling to 17 degrees C reduced purpura ( 0.88 ) and pain ( 0.76 ) even more , the clearance ( 2.06 ) was lowered marginally . Most patients preferred cooling to 20 degrees C skin temperature . CONCLUSION In dermatological laser therapy of facial telangiectasia , the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance . Cooling to 20 degrees C skin temperature proved to be a well-balanced middle course . For the practical use of cold air cooling , we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy densities BACKGROUND AND OBJECTIVES The use of the long-pulsed 755-nm alex and rite laser has been an effective tool in hair removal . A dynamic cooling device ( DCD ) is commonly used with this laser in order to minimize epidermal damage . No studies have examined how fine changes in DCD duration may affect comfort and epidermal damage during laser hair removal . This study was design ed to determine what effect , changes in the duration of dynamic cooling would have on pain and epidermal damage with laser hair removal ( 755 nm alex and rite ) in patients with darker skin types . STUDY DESIGN / MATERIAL S AND METHODS Ten volunteers with Fitzpatrick skin types III-V were enrolled . A 755-nm alex and rite laser with a pulse duration of 3 milliseconds and equipped with a DCD was used with the 12 mm spot size on matched treatment sites . We compared cryogen spurt duration s of 0 , 20 , 40 , 60 , 80 , and 100 milliseconds on pain and epidermal changes . The spray delay was set at 1 millisecond . Pain rating scales and epidermal changes ( skin sloughing , hyperpigmentation , hypopigmentation and scarring ) were assessed . RESULTS Overall a decrease in pain was seen with increases in spurt duration . A spurt duration of 20 milliseconds was beneficial for pain reduction in all patients . Longer spurt duration s were associated with additional pain relief especially when geographic spacing of pulses was maximized to prevent thermal build-up . In regards to epidermal protection , most patients benefited with shorter cryogen duration s of 20 - 60 milliseconds . There was little advantage with longer spurt duration s. Some patients treated at higher fluences without cooling had no detectable side effects . CONCLUSIONS Increasing DCD spurt duration in laser hair removal provides its strongest benefit in the area of pain reduction , particularly in type V patients . Increasing cryogen spurt duration s above a protective threshold shows no significant benefit in terms of epidermal protection . Changing the spurt duration may not be as important in some patients with darker skin types Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales . DESIGN  Multiple simultaneous pain assessment s by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( VRS-4 ) and an 11-point numeric rating scale ( NRS-11 ) with a 100-mm visual analog scale ( VAS ) . The sensitivity of the scales ( i.e. , their ability [ power ] to detect differences between treatments ) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size . RESULTS There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient . Simulation experiments showed that the VAS was systematic ally more powerful than the VRS-4 in all simulations performed . The sensitivity of the VAS and NRS-11 was approximately equal . CONCLUSIONS In this acute pain model , the VRS-4 was less sensitive than the VAS . The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity . The choice between the VAS and NRS-11 can thus be based on subjective preferences BACKGROUND A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures . A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and , once air dried , is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery . OBJECTIVE To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing . METHODS A series of 20 patients undergoing full-face single-pass CO2 laser resurfacing were enrolled in a double-blind institutional review board (IRB)-approved study protocol in which two different topical anesthetic products were compared . A 4 cm × 4 cm area of one cheek was r and omized to receive the novel lidocaine/tetracaine-based cream peel ( S-Caine ) while a 4 cm × 4 cm area on the contralateral side received EMLA cream with occlusion for 30 minutes prior to laser treatment . Patients rated the level of pain experienced during laser treatment on each side using a visual analog scale . Independent assessment s of observed discomfort and side effects were recorded RESULTS Pain scores were significantly lower using the novel lidocaine/tetracaine-based cream peel formulation compared with the EMLA cream . Side effects associated with application of the anesthetic peel were limited to mild transient erythema and skin blanching . CONCLUSION A novel topical lidocaine/tetracaine-based cream peel provides safe and effective dermal anesthesia for single-pass CO2 laser skin resurfacing Background : Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post‐treatment erythema and edema . The sensation of pain associated with the treatment is immediate and acute . Application of topical anesthesia is time‐consuming , with only very moderate pain relief . Objective : ( a ) To test pain reduction as well as the reduction of post‐treatment erythema and edema when using pneumatic skin flattening ( PSF ) . This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin . The result is an afferent inhibition of pain transmission in the dorsal horn ( the ‘ gate theory ’ ) . ( b ) To test the efficacy of PSF . Methods : Twenty patients were treated for solar lentigines . The patients were treated by three different IPLs . The evaluation of acute pain and post‐treatment erythema and edema was performed on all 20 patients : one to three sites per patient treated with PSF and the same number of control sites without PSF . Identical energies and IPL were applied to both sites on each patient . The pain evaluation was performed on a 10‐level scale modified McGill Pain Question naire . The clinical response to treatment was also evaluated . Results : All 20 patients completed the study and preferred the PSF treatment side over the non‐PSF side . Substantial pain reduction was observed in 19/20 patients ( 95 % ) . The average reduction of pain was by two levels , from very painful to very mild pain . Erythema reductions were observed on 14/18 ( 77 % ) patients and edema reduction on 8/9 ( 88 % ) patients . Treatment efficacy on PSF sites was identical to that of non‐PSF sites . Conclusion : The pneumatic skin flattening ( PSF ) technology considerably reduces pain , erythema and edema in the treatment of solar lentigines by IPLs . Treatment efficacy is preserved . The enhanced safety of PSF enables the increase of energy density and the acceleration of results The purpose of this study was to vali date the changes in acute pain measurement scales that are most strongly associated with a patient-determined indicator of clinical importance . Measures of pain intensity and pain relief are commonly used outcomes in therapeutic clinical trials . Recent studies of the properties of acute pain measures have provided data defining the cut-off points that are best associated with clinical ly important differences . Validation of these findings in another clinical trial data set is important . Data were obtained from the titration phase of a recently conducted r and omized controlled clinical trial of oral transmucosal fentanyl citrate ( OTFC ) , which compared OTFC to immediate release morphine sulfate ( MSIR ) for the treatment of cancer-related acute breakthrough pain .  Changes in pain intensity and pain relief were recorded every 15 minutes for 60 minutes and global medication performance recorded at the end of each study pain episode . At any titration step , if the patient felt that the first dose of the study medication did not provide adequate relief within 30 minutes , an additional rescue medication could be taken . To find the level of each pain scale best associated with this measure of the adequacy of pain relief , the calculated sensitivity , specificity , and accuracy for different cut-off points of the measured pain scales were compared to whether or not the patient needed rescue medication . The overall ability of the pain measures to discriminate episodes for which a rescue was not needed was calculated using area under the receiver operating characteristics ( ROC ) curves . Data were analyzed from 134 OTFC-naive patients who collected data on 1307 episodes of breakthrough pain . Using the criteria of a balanced sensitivity and specificity , the best cut-off points were determined to be : 33 % for the percent pain intensity difference ; > or = 2 for the raw pain intensity difference on a 0 - 10 numeric rating scale ; > or = 2 ( i.e. , moderate or better ) for pain relief ; > or = 33 % for the percent maximum total pain relief ; and > or = 2 ( good or better ) for global medication performance . ROC area under the curve ranged from 0.839 to 0.862 for each of the pain measures listed above , calculated at 60 minutes . These data indicate that the pain scale cut-off points that are best associated with a patient-derived measure of a clinical ly important difference closely approximate those found in an earlier study . ROC analysis provided evidence that the overall pain measures were strongly associated with not requiring an " additional dose of rescue medication . " Thus , the cut-off points determined for these pain scales provide a good surrogate measure of a patient-determined clinical ly important response . This provides support for the usefulness of these values in future clinical trials of pain therapy OBJECTIVES To determine the minimum clinical ly significant difference in visual analog scale ( VAS ) pain scores for acute pain in the ED setting and to determine whether this difference varies with gender , age , or cause of pain . METHODS A prospect i ve , descriptive study of 152 adult patients presenting to the ED with acute pain . At presentation and at 20-minute intervals to a maximum of three measurements , patients marked the level of their pain on a 100-mm , nonhatched VAS . At each follow-up they also gave a verbal rating of their pain as " a lot better , " " much the same , " " a little worse , " or " much worse . " The minimum clinical ly significant difference in VAS pain scores was defined as the mean difference between current and preceding scores when pain was reported as a little worse or a little better . Data were compared based on gender , age more than or less than 50 years , and traumatic vs nontraumatic causes of pain . RESULTS The minimum clinical ly significant difference in VAS pain scores is 9 mm ( 95 % CI , 6 to 13 mm ) . There is no statistically significant difference between the minimum clinical ly significant differences in VAS pain scores based on gender ( p=0.172 ) , age ( p=0.782 ) , or cause of pain ( p=0.84 ) . CONCLUSIONS The minimum clinical ly significant difference in VAS pain scores was found to be 9 mm . Differences of less than this amount , even if statistically significant , are unlikely to be of clinical significance . No significant difference in minimum significant VAS scores was found between gender , age , and cause-of-pain groups Port-wine stains may be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm . However , the discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions . Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use . We performed a prospect i ve double-blind , placebo-controlled evaluation of the iontophoresis of lidocaine HCl 4 % and lidocaine HCl 4 % with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port-wine stains . Eleven patients with port-wine stains completed the initial phase of the study .  Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4 % and lidocaine HCl 4 % with epinephrine 1:50,000 ( P less than .0001 ) , with no significant difference between these treatments . Follow-up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port-wine stains , despite significant decreases in perfusion , as measured by laser Doppler velocimetry , of port-wine stain areas receiving iontophoresis of lidocaine with epinephrine . Iontophoresis of lidocaine HCl 4 % with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy BACKGROUND AND OBJECTIVES Advancements in laser treatment of leg veins necessitate concurrent investigations in topical anesthesia to minimize treatment-related pain . To evaluate the efficacy of the S-Caine Peel for providing topical anesthesia after a 60-minute application . STUDY DESIGN / PATIENTS AND METHODS A r and omized , double-blinded , placebo-controlled trial was performed in two centers . Sixty patients received S-Caine Peel and placebo vehicle  on different treatment sites for 60 minutes prior to laser treatment of leg veins using a 1,064 nm long-pulsed Nd : YAG laser .  Patients rated their level of pain using a visual analog scale . Adequacy of anesthesia and expressed pain at each site were rated by the investigator . RESULTS The mean visual analog scale ( VAS ) was 27 mm for active sites compared to 43 mm for placebo ( P < 0.001 ) . Improved pain relief was noted for 67 % of active versus 30 % of placebo sites ( P < 0.001 ) . Anesthesia was judged adequate by the investigator for 55 % of active compared with 12 % of placebo sites ( P < 0.001 ) . CONCLUSIONS The S-Caine Peel is safe and effective when applied for 60 minutes prior to laser therapy of leg veins BACKGROUND The use of cryogen spray cooling in the course of dye laser treatment of port-wine stains has established itself in recent years because of its good analgesic and epidermally protective effects . The disadvantages of this kind of evaporative cooling are the cost and , in the case of dichlorodifluoromethane , the effects on the ozone layer . Cold air is an innovative cooling method that costs nearly nothing to use , is environmentally friendly , and can be easily adapted to existing laser systems . OBJECTIVE To examine and evaluate cold air cooling as an alternative method of cooling in laser treatment . METHODS In a prospect i ve study , 13 patients ( 9 female , 4 male ) with port-wine stains were treated with a pulsed dye laser ( λ = 585 nm , τp = 450 μsec ) . In every case , either the entire area or a sample area of the port-wine stain was treated with cold air cooling on 50 % of the surface and without on the other 50 % . Clearance , analgesia , and adverse and concomitant effects were assessed . RESULTS In nine patients ( 69 % ) there were similar results in terms of clearance . In four cases , better lightening results ( in two patients ) and worse lightening results ( in two other patients ) were achieved in the area treated with cold air . Nine of the patients ( 69 % ) felt that the laser impulses accompanied by cold air were significantly less painful . Adverse effects ( purpura , erythema , edema ) and concomitant effects ( hypopigmentation , hyperpigmentation , scars ) were much less marked in the cooled areas . CONCLUSION Cold air is a safe and effective alternative to cryogen spray cooling . It is easy to use , economical , and environmentally friendly . Continuing studies are necessary to determine if there are interactions which affect the tissue BACKGROUND The measurement of spasticity as a symptom of neurologic disease is an area of growing interest . Clinician-rated measures of spasticity purport to be objective but do not measure the patient 's experience and may not be sensitive to changes that are meaningful to the patient . In a patient with clinical spasticity , the best judge of the perceived severity of the symptom is the patient . OBJECTIVES The aim of this study was to assess the validity and reliability , and determine the clinical importance , of change on a 0 - 10 numeric rating scale ( NRS ) as a patient-rated measure of the perceived severity of spasticity . METHODS Using data from a large , r and omized , doubleblind , placebo-controlled study of an endocannabinoid system modulator in patients with multiple sclerosis-related spasticity , we evaluated the test-retest reliability and comparison-based validity of a patient-reported 0 - 10 NRS measure of spasticity severity with the Ashworth Scale and Spasm Frequency Scale . We estimated the level of change from baseline on the 0 - 10 NRS spasticity scale that constituted a clinical ly important difference ( CID ) and a minimal CID ( MCID ) as anchored to the patient 's global impression of change ( PGIC ) . RESULTS Data from a total of 189 patients were included in this assessment ( 114 women , 75 men ; mean age , 49.1 years ) . The test-retest reliability analysis found an interclass correlation coefficient of 0.83 ( P < 0.001 ) between 2 measures of the 0 - 10 NRS spasticity scores recorded over a 7- to 14-day period before r and omization . A significant correlation was found between change on 0 - 10 NRS and change in the Spasm Frequency Scale ( r = 0.63 ; P < 0.001 ) , and a moderate correlation was found between the change on 0 - 10 NRS and the PGIC ( r = 0.47 ; P < 0.001 ) . A reduction of approximately 30 % in the spasticity 0 - 10 NRS score best represented the CID and a change of 18 % the MCID . CONCLUSIONS The measurement of the symptom of spasticity using a patient-rated 0 - 10 NRS was found to be both reliable and valid . The definitions of CID and MCID will facilitate the use of appropriate responder analyses and help clinicians interpret the significance of future results The time of onset and duration of local anesthesia of a lidocaine/prilocaine cream ( EMLA ) applied to the genital mucosa were assessed in a double-blind study . Eighty women with condylomata on their genital mucosa were r and omly allocated to either EMLA ( N = 60 ) or placebo cream ( N = 20 ) between 1 - 75 minutes before CO2 laser treatment . The pain was evaluated by the patient on a visual analogue scale . The most effective degree of anesthesia was achieved after 5 - 15 minutes ' application of EMLA . The patients given EMLA , regardless of application time , felt significantly less pain than the patients given placebo . EMLA could provide an alternative to general anesthesia in patients with extensive condylomata on the genital mucosa We have used EMLA , 4 % amethocaine gel and placebo for facial portwine stains , for a period of 1 h , in a double-blind study . After removal of the preparations from the skin surface , each area was treated with six pulses of the laser , each 5 mm in diameter . Any pain noted immediately after treatment was recorded using both visual analogue ( VAS ) and verbal rating ( VRS ) scores .  Twenty nine patients completed the study and statistical analysis of the results indicated that both EMLA and 4 % amethocaine gel were superior to placebo ( P < 0.001 ) . However , when EMLA and 4 % amethocaine gel were compared , the amethocaine preparation was significantly better ( P < 0.05 , VAS ; P < 0.005 VRS ) than EMLA in reducing pain caused by the laser treatment BACKGROUND Penetration through the stratum corneum limits effectiveness of topical anesthetics . OBJECTIVE Our aim was to evaluate the effectiveness of 5 % lidocaine ( ELA-Max ) cream applied after erbium : yttrium-aluminum-garnet ( Er : YAG ) laser ablation of the stratum corneum . METHODS R and omized , controlled , split-face comparison of anesthesia was performed on 12 volunteers . The stratum corneum was painlessly ablated with a low-fluence Er : YAG laser on half of the face , then the whole face was covered with ELA-Max cream for 60 minutes . Full-face laser resurfacing was performed , and visual analog pain scores ( 0 to 10 ) were recorded during each of 2 passes . RESULTS Laser-assisted topical anesthesia demonstrated significantly lower mean pain scores than topical anesthesia alone . This was more pronounced during the more painful second pass . Resurfacing after laser-assisted topical anesthesia was well tolerated by 72 % of subjects in pass 1 and 58 % in pass 2 . CONCLUSION Laser-assisted topical anesthesia is fast , painless , and substantially more effective than conventional topical anesthesia but does not provide adequate anesthesia for full-face resurfacing in all subjects Port-wine stains ( PWS ) are benign , congenital vascular malformations found in approximately 0.3 % of newborns . PWS may be effectively treated with the flashlamp pulsed dye laser ( FPDL ) at 585 nm . However , laser therapy of vascular lesions often produces pain . We performed a prospect i ve double-blind , placebo-controlled evaluation of the iontophoresis of lidocaine 5 % with epinephrine 1:50,000 and mepivacaine 2 % with epinephrine 1:50,000 .  Thirty-six patients with facial PWS were included in the study ; 13 of them were treated with lidocaine 5 % with epinephrine , another 13 were treated with mepivacaine 2 % with epinephrine , and the other 13 were treated with preservative-free 0.9 % NaCl . The pain was grade d by the patient on a visual analog scale from 0 to 10 , comparing the iontophoretically treated area with an adjacent area treated without anesthesia . Pain evaluation by patients demonstrated a significant decrease in the pain of pulsed dye laser impulses using the iontophoresis of lidocaine 5 % with epinephrine . No change in the efficacy of pulsed dye laser treatment of PWS or important side effects were observed in our patients . Iontophoresis of lidocaine 5 % with epinephrine is a safe and effective method of local anesthesia for pulsed dye laser and it is more effective than the iontophoresis of mepivacaine 2 % with epinephrine BACKGROUND Laser-assisted hair removal is a variably uncomfortable and painful procedure . OBJECTIVE The aim of this study was to investigate the efficacy of piroxicam gel on pain control and subsequent inflammation in Nd : YAG 1064 nm laser hair removal in women volunteers . METHODS Fifty women volunteers were enrolled in this prospect i ve , r and omised , placebo-controlled study over a 6-month period . Subjects were r and omly assigned to receive piroxicam gel as Group P or saline as a control group . Topical analgesic and saline were applied to the treatment sites for 45 minutes . The pain scores ( VAS ) and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and after 1 hour , 2 hours and 24 hours after the hair removal . RESULTS Subject characteristics and treatment setting s in Nd : YAG 1064 nm laser were similar in both groups . The pain scores ( VAS ) were significantly lower in the Group P than those of the control group during the hair removal ( p < 0.001 ) . Inflammatory side effects such as erythema , edema , and folliculitis , were more frequent in the control group than those of Group P during the procedure ( p < 0.001 ) . CONCLUSION This study showed that piroxicam gel provided adequate pain relief after Nd : YAG 1064 nm laser hair removal in women volunteers .  Piroxicam gel was associated with lesser inflammatory side effects when compared to placebo because of its anti-inflammatory effect after the procedure BACKGROUND Advancements in nonablative laser technology necessitate concurrent developments in topical anesthesia , as patients have reported varying degrees of discomfort during these procedures . Although topical anesthetics have proven efficacious , they possess inherent limitations related to ease of use . OBJECTIVE To evaluate the efficacy of the S-Caine Peel ( ZARS Inc. , Salt Lake City , UT ) , a novel topical anesthetic that dries to form a flexible membrane , for induction of anesthesia after only a 30-minute application period . METHOD Twenty patients received concurrent 30-minute applications of both the S-Caine Peel and a placebo cream r and omized  to the right and left cheeks in a double-blinded manner . After one pass of the 1450-nm diode laser ( Smoothbeam , C and ela Corp. , Wayl and , MA ) , patients ' pain levels were recorded on a visual analog scale ( VAS ) . Both the investigator and an independent observer rated perceived discomfort and immediate skin reaction based on a numerical scale . RESULTS Differences in VAS scores between active sites ( average rating of 15 mm ) and placebo sites ( average rating of 47 mm ) were statistically significant ( P<0.001 ) . A painless procedure was noted at 50 % and 65 % of active sites by the independent observer and investigator , respectively . This was statistically different ( P<0.001 ) from the independent observer and investigator perception of pain-free procedure at the placebo site , 0 % and 5 % , respectively . CONCLUSION The S-Caine Peel provided effective and safe dermal anesthesia after only a 30-minute application period for nonablative laser treatment with the 1450-nm diode laser . The unique vehicle readily delivers anesthetic to contoured regions of the body and eliminates the need for occlusion Laser hair removal is an effective therapy for the treatment of hirsutism , hypertrichosis , and pseudofolliculitis barbae . Although side effects are uncommon , pain is described by most patients undergoing long-pulsed neodymium : yttrium-aluminum-garnet ( Nd : YAG ) 1,064 nm laser therapy . objectives To compare the efficacy of topical eutectic mixture of local anesthetics ( EMLA ) versus topical lidocaine ( LMX ) in pain control for Nd : YAG 1,064 nm laser hair removal . Methods Sixty-four patients were enrolled in a double-blind r and omized study over a 6-month period . Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment . Neither was applied under occlusion . Immediately following their treatment session , patients completed a visual analog pain scale . Results There was no statistically significant difference in pain control between EMLA and LMX . However , female test subjects demonstrated lower pain scores than male test subjects . Conclusions Nd : YAG 1,064 nm laser hair removal is a painful procedure . Topical anesthetics have been proven to reduce pain for laser hair removal . There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal . Therefore , cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic BACKGROUND AND OBJECTIVE The long-pulse dye laser ( PDL ) at 595 nm and pulse duration of 1.5 msec has been shown to improve clearance of larger vessels such as those seen in leg telangiectasia . The objectives of this study are twofold . First , to determine the effect of the dynamic cooling device ( DCD ) in clearance of leg telangiectasia by using a long-pulse PDL at 595 nm . Next , to determine the effect of the DCD in reducing transient discomfort associated with treatment and in reducing epidermal damage ( blistering , hyper/hypopigmentation , scarring ) caused by the laser . STUDY DESIGN / MATERIAL S AND METHODS Matched treatment sites were compared at energy densities of 20 and 24 J/cm(2 ) with and without the use of the cryogen spray  in 18 patients . In areas treated without the DCD , the laser pulse was delivered through a single layer of Spenco Second Skin . Patients received two treatments 6 weeks apart . Discomfort ratings , clearance of leg telangiectasia , and complications were assessed at 6 weeks , 12 weeks , and 6 months . RESULTS A reduction in discomfort ratings was found in most patients using the DCD . Six-month follow-up data revealed at the 20 J/cm(2 ) treatment sites , with or without the DCD , 76.9 % showed greater than 50 % clearance . At the 24 J/cm(2 ) treatment sites , with or without the DCD , 84.6 % showed greater than 50 % clearance . CONCLUSION The long-pulse dye laser at 595 nm with a 1.5-msec pulse duration cleared leg telangiectasia an average of 67.5 % with two treatments at 6 months . The major effect of the DCD was on pain reduction . There was no difference in clearance rates when using the DCD vs. cooled Second Skin . Further studies with longer cooling times with the DCD are needed to optimize treatment parameters BACKGROUND AND OBJECTIVE Pulsed KTP lasers effectively treat facial telangiectasia without purpura production . Transient side effects following treatment include erythema , edema , and vesiculation leading to crust formation . The aim of this study was to investigate the utility of an aqueous gel in reducing side effects associated with pulsed KTP laser treatment of facial telangiectasia . STUDY DESIGN / MATERIAL S AND METHODS Nineteen patients with extensive facial telangiectasias were treated with a pulsed KTP laser ( Versapulse , Coherent , Palo Alto , CA ) . The laser was used with the water cooled h and piece chilled to 4C , a 4 mm spot size , a 10-millisecond pulse duration and a fluence of 9.5 J/cm2 . One side of the face was treated with the laser using the cooling h and piece alone . The other side was treated using the cooling h and piece applied to a 2-mm film of aqueous gel spread over the treatment area . RESULTS Treatment side effects , including pain , erythema , edema , vesiculation , and crusting were scored following treatment with and without the aqueous gel . Use of the aqueous gel in conjunction with the cooling h and piece decreased the incidence and severity of pain , erythema , edema , and crusting following pulsed KTP laser treatment of facial telangiectasia . Most patients demonstrated 50 - 75 % clearance of their telangiectasias 1 month after one treatment session , and use of the gel did not alter the treatment efficacy . CONCLUSIONS The application of an aqueous gel during pulsed KTP laser treatment of facial telangiectasia improves treatment associated side effects without affecting vessel clearance BACKGROUND Topical anesthetics are valuable tools for many dermatologic procedures . OBJECTIVE To evaluate the efficacy and safety of S-Caine Peel composed of 1:1 ( wt : wt ) mixture of 7 % lidocaine and 7 % tetracaine in the induction of local anesthesia before long-pulsed Nd : YAG laser therapy for leg veins . METHODS Two r and omized , double-blinded , placebo-controlled trials were performed . In study 1 , 60 adults received S-Caine Peel and placebo cream  for 30 or 60 minutes . Efficacy was evaluated by a patient visual analog scale and impression . The pain scale and impression were evaluated by the investigator and an independent observer . In study 2 , 40 adults received 60- and 90-minute applications . RESULTS In study 1 , the 30- and 60-minute application times were grouped : Patients had adequate pain relief in 48 % of S-Caine sites versus 23 % of placebo sites ( P<0.001 ) . Investigators reported none-to-mild pain in 50 % of active sites versus 33 % of placebo sites ( P = 0.007 ) , with adequate anesthesia in 65 % of active sites versus 43 % of placebo sites ( P = 0.002 ) . The independent witness assessed none-to-mild pain in 52 % of active sites versus 37 % of placebo sites ( P = 0.067 ) . In study 2 , investigators rated none-to-mild pain in 75 % of 60-minute and 85 % of 90-minute S-Caine sites versus 30 % and 50 % of placebo sites ( P = 0.012 and P = 0.002 , respectively ) , with adequate anesthesia in 70 % and 85 % of 60- and 90-minute of active sites versus 25 % and 20 % of placebo sites ( P = 0.029 and P = 0.001 , respectively ) . The independent witness rated none to mild pain in 80 % and 85 % of 60 and 90 minute of S-Caine sites versus 35 % and 50 % of placebo sites ( P = 0.008 and P = 0.004 ) . CONCLUSION The S-Caine Peel provides safe and highly effective local anesthesia when applied for at least 60 minutes for laser therapy of leg veins . Facile removal of the peel provides a unique advantage and ease in administration Background Topical anesthetics are important tools for many dermatologic procedures . The S-Caine Peel is composed of a 1:1 ( w : w ) eutectic mixture composed of lidocaine base 7 % , USP , and tetracaine base 7 % , USP . It is applied as a cream , dries on exposure to air , and forms a flexible membrane , which can be easily peeled off . Objective To evaluate the effectiveness of the S-Caine Peel in providing clinical ly useful local dermal anesthesia for laser-assisted tattoo removal and to monitor the nature and frequency of adverse events associated with the safety of the S-Caine Peel . Methods Thirty adult patients undergoing laser-assisted tattoo removal were enrolled in this multicentered , r and omized , double-blind , placebo-controlled study . Each subject received both the S-Caine Peel and placebo simultaneously for 60 minutes . The primary efficacy parameter was a 100 mm visual analog scale ( VAS ) for patient self- assessment of pain . Secondary efficacy parameters included both the investigator 's and an independent observer 's evaluation of subject pain ( 4-point categorical scale : no pain through severe pain ) and the patient 's and the investigator 's overall impression of the local anesthetic . Results Mean VAS scores were 42 mm for the S-Caine Peel and 66 mm for placebo treatment sites ( p= .001 ) . Patients received adequate pain relief in 50 % of S-Caine Peel sites versus 7 % of placebo sites ( p= .002 ) . The percentage of those who would like to use the S-Caine Peel again were 43 % for the S-Caine Peel compared with 7 % for placebo ( p= .005 ) . Investigators ' evaluations revealed that 70 % of patients had less pain at S-Caine Peel treatment sites compared with 10 % with less pain at placebo sites ( p < .001 ) , and 70 % of the S-Caine Peel – treated sites achieved adequate anesthesia versus 10 % of placebo sites ( p < .001 ) . The independent witness assessed less pain in 67 % of S-Caine Peel – treated sites versus 10 % of the placebo sites ( p= .002 ) . One occurrence of moderate to severe erythema was noted at both an S-Caine Peel and a placebo treatment site on removal of the S-Caine Peel after 60 minutes , which self-resolved quickly . There was no statistical difference between the two groups . Other side effects were limited to local mild , transient erythema at the application sites . Conclusion Administration of the S-Caine Peel for 60 minutes prior to laser-assisted tattoo removal was effective in significantly reducing pain levels associated with the procedure
target: In general , active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia , and topical anaesthetic drugs and PSF seemed to result in a better pain reduction than skin cooling .
  However , the current evidence is insufficient to provide recommendations for daily clinical practice .
  Future studies should also evaluate sex differences in pain perception , have uniformity with regard to vali date d pain measurement scales and address clinical ly significant differences in pain reduction besides statistically significant differences
background: Pain is a common side-effect of dermatological laser procedures .
  Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy .
  However , it remains unclear which method provides the best pain relief .
  The objective of this systematic review was therefore to assess the efficacy and safety of non-invasive anaesthetic methods during dermatological laser procedures .