Allergic Contact Dermatitis from EMLA Cream in a Hemodialyzed Patient
Allergic Contact Dermatitis from EMLA Cream in a Hemodialyzed Patient
The eutectic mixture EMLA cream has many medical uses, including pain relief for hemodialyzed patients prior to cannulation. Cutaneous side effects associated with its application have rarely been reported. A patient on hemodialysis developed an itchy eruption over his brachial arteriovenous fistula, where he was applying EMLA cream three times per week, prior to puncture for hemodialysis. Patch testing elicited a positive reaction to several allergens, including EMLA cream "as is" and prilocaine. The lesions resolved after topical treatment with corticosteroids.
Hemodialyzed Patients may present diverse cutaneous reactions in relation to the topical application of many substances. These include local anesthetics, widely used for providing pain relief to patients undergoing hemodialysis.
EMLA cream (AstraZeneca Farmaceutica, Madrid, Spain), whose name is an acronym for "eutectic mixture of local anesthetics" (ie, prilocaine and lidocaine), was first commercialized in 1984 and is available as cream and as patches. It is widely used prior to several medical procedures, such as venipuncture, lumbar puncture, laser therapy, curettage of molluscum contagiosum, vaccination, skin biopsy, intradermal testing, cryosurgery, and therapy with botulinum toxin ( Table 1 ).
We report a case of contact dermatitis induced by EMLA cream in a hemodialyzed patient with a positive patch-test reaction to prilocaine and polysensitization to other allergens without present relevance. We did not find positive reactions to other local anesthetics.
Abstract and Introduction
Abstract
The eutectic mixture EMLA cream has many medical uses, including pain relief for hemodialyzed patients prior to cannulation. Cutaneous side effects associated with its application have rarely been reported. A patient on hemodialysis developed an itchy eruption over his brachial arteriovenous fistula, where he was applying EMLA cream three times per week, prior to puncture for hemodialysis. Patch testing elicited a positive reaction to several allergens, including EMLA cream "as is" and prilocaine. The lesions resolved after topical treatment with corticosteroids.
Introduction
Hemodialyzed Patients may present diverse cutaneous reactions in relation to the topical application of many substances. These include local anesthetics, widely used for providing pain relief to patients undergoing hemodialysis.
EMLA cream (AstraZeneca Farmaceutica, Madrid, Spain), whose name is an acronym for "eutectic mixture of local anesthetics" (ie, prilocaine and lidocaine), was first commercialized in 1984 and is available as cream and as patches. It is widely used prior to several medical procedures, such as venipuncture, lumbar puncture, laser therapy, curettage of molluscum contagiosum, vaccination, skin biopsy, intradermal testing, cryosurgery, and therapy with botulinum toxin ( Table 1 ).
We report a case of contact dermatitis induced by EMLA cream in a hemodialyzed patient with a positive patch-test reaction to prilocaine and polysensitization to other allergens without present relevance. We did not find positive reactions to other local anesthetics.