The best numbing cream for skin procedures is one that provides profound anesthesia. It should do this in the shortest time possible and last long enough to complete the treatment being performed. If the patient starts feeling pain during the procedure, it can cause serious issues for the success of the procedure and the comfort of the patient. Many professional providers of aesthetic services like laser resurfacing, microneedling, and injectable treatments choose a compounded topical anesthetic instead of an over-the-counter product. This is to ensure the best experience for their patients as well as to increase the success of their procedures.
Is there anything stronger than lidocaine?
Lidocaine is a potent anesthetic that is made in a variety of forms. It is effective at numbing the skin and for use as an infiltrative local anesthetic. A topical that is stronger than lidocaine is one with more than just lidocaine. When lidocaine is combined with benzocaine and tetracaine, it provides stronger anesthesia. When discussing the strength of an anesthetic, it can really depend on the concentration, where it is applied, how much is applied, what form it is applied in, and many other factors. The highest strength lidocaine that is available over-the-counter is 5% strength.
What is BLT cream?
BLT cream stands for benzocaine, lidocaine, and tetracaine cream. Several different strength combinations can be made. A common formulation is benzocaine 20%, lidocaine 6%, and tetracaine 4%. BLT cream is a compounded topical anesthetic. That means that it is not available for sale from a regular pharmacy or medical supplier – it must be compounded by a trained pharmacist. This standardized numbing cream formulation has been made for many years and is stable, effective, and safe when used appropriately.
How do you prescribe BLT cream?
BLT cream can be prescribed with a provider’s own prescription forms or using the prescription forms provided by our pharmacy. If you are obtaining your BLT cream from a 503A compounding pharmacy, prescriptions are required per FDA and the Food, Drug, and Cosmetic Act. 503B pharmacies may compound without a prescription but they are less common than 503A pharmacies. Typically this formulation is prescribed by dermatologists and other licensed professional who perform procedures on the skin.
How long does it take BLT cream to work?
BLT cream will provide anesthesia in about 20 minutes after application. You may experience numbing sooner than that, but to get the maximum effect it should be left on for at least 20 minutes before being thoroughly removed.
Applications of BLT cream
BLT cream is applied with a gloved hand or applicator to the area being treated. After numbing is achieved, the cream should be completely removed and the area thoroughly washed. Numbing cream should not be applied to large surface areas of the body. It may be preferable, for example, to only numb and treat half the face at a time. A large area of the body should never be numbed at the same time as this can increase plasma levels of anesthetic and create adverse effects. If you are numbing prior to hair removal on the legs, the entire leg should not be numbed at the same time. Proceed in sections, numbing and treating smaller areas to prevent toxicity. It may be that the treatment needs to be broken up into multiple appointments to do this effectively.
See more numbing cream tips here.
Why use BLT cream and not another topical anesthetic?
BLT cream provides a more profound anesthesia than typical OTC topical anesthetics. If you are looking to make a skin procedure more comfortable, a more powerful topical anesthetic can do that. In short, BLT cream is what the professionals use. Numerous OTC numbing products exist for managing everything from bug bites to burns to numbing before getting a tattoo. A compounding pharmacy makes formulations specifically for numbing prior to more intense skin procedures while adhering to high quality standards.
Why use a compounding pharmacy to make BLT cream?
While lidocaine and benzocaine can be sold on their own without a prescription, the combination of lidocaine, benzocaine, and tetracaine in one cream must be made by a compounding pharmacy. A compounding pharmacy must meet high regulatory and quality standards to ensure the products they make are consistent and safe. Purchasing separate ingredients, and trying to compound in the office, can lead to an inconsistency in the amount of anesthetic being applied. Most offices do not have the equipment to ensure that a uniform, consistent product is produced from the combining of anesthetic ingredients.
What formulations of BLT cream can be made?
These are some common formulations of BLT cream that can be made by a compounding pharmacy:
- Benzocaine 20%, Lidocaine 6%, Tetracaine 4%
- Benzocaine 20%, Lidocaine 8%, Tetracaine 4%
- Benzocaine 20%, Lidocaine 10%, Tetracaine 4%
- Lidocaine 23%, Tetracaine 7% (LT cream)
There may be some variations on these standard formulations. However the formulations listed above have been proven to work and will serve the purposes of most dermatology and aesthetic practices.
What are the side effects and precautions for BLT cream?
The most common cause of adverse effects from BLT cream is that the cream was applied by an individual on themselves in a way that caused systemic toxicity. Large areas of the body should not be numbed at the same time.
Methemoglobinemia is one risk of some topical anesthetics. This is a condition where the oxygen levels in the blood are diminished. One of the characteristic symptoms of this condition is blue-colored skin. Other symptoms include dizziness, headache, nausea, and difficulty breathing.
Broken and inflamed skin should not have any numbing cream applied to it. It is important to remove all cream before starting a procedure that will cause intentional damage to the skin. Once the skin has been damaged, numbing cream should not be applied.
Articles
Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study – Journal of Dental Anesthesia and Pain Medicine
Topical anesthesia – Journal of Anaesthesiology, Clinical Pharmacology