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.
Commercially Available Products and the Search for the Best Numbing Cream
There are a variety of resources for finding over-the-counter numbing solutions, like this article from Byrdie. While these products all seem quite different and tout different benefits, they are mostly just lidocaine 5% creams and ointments. If you look at a list like this, you will see a variety of packaging styles with different colors and sizes that all contain lidocaine 5%. Some people may benefit from a topical that has this strength of an anesthetic, but it also might not be strong enough for many patients. A compounded topical anesthetic can offer more anesthetic ingredients in higher concentrations, because it is custom-made with a prescription.
These over-the-counter formulations can include other ingredients that do not change the topical’s effectiveness. For example, some numbing creams can have vitamin E, aloe, or other moisturizing ingredients. Since a numbing cream is only applied once before a procedure and not on a daily basis, there is not much use in having a moisturizer added to the formulation except to increase the price by adding more to the label.
A compounded medication may be a better numbing cream for skin procedures because it can include higher concentrations of anesthetics in unique combinations. Compounded medications also do not include extra ingredients that are not necessary for the topical’s effectiveness. There are no added excipients like aloe vera that look nice on a label but don’t necessarily add to a product you are only going to use occasionally at an appointment for a skin procedure.
What is FDA Approval?
None of the over-the-counter numbing creams you find are “FDA approved” in the way a drug you get at your local pharmacy is approved. Certain medication ingredients are considered safe to use over-the-counter with a prescription, but there are few rules on who can market and sell them. That is why there are likely hundreds of different types of over-the-counter creams that all contain lidocaine 5%. Compounded medications are also not FDA-approved – they are prescribed by doctors to be used “off-label.” The FDA approval process is long and requires years of research studies to demonstrate safety and efficacy. For cosmetic ingredients in drugstore creams, there is very little to no approval process.
A compounding pharmacy will make a topical anesthetic cream that includes ingredients that are all individually found in a commercially available product, but when combined, can not be found in anything you can get from a typical pharmacy. While no compounded numbing cream is FDA approved, it is required to meet high standards, and the process must meet USP 795 guidelines and state and federal regulations.
How Can You Know What the Best Numbing Cream Is?
A numbing cream that you use for a minor injury or for an oral sore that you get over-the-counter doesn’t need to be as strong as a compounded numbing cream. So the “best numbing cream” for an oral sore is likely an over-the-counter one since it better suits the purpose. You never want to use more of a drug than you actually need, as a higher concentration of the drug may cause toxicity. However, if you are trying to numb an area prior to a skin procedure in a dermatology office, you are probably going to want something stronger. The best numbing cream for a skin procedure is not one that is going to go away in a few minutes or not fully numb the area. You will want it to remain effective for the entire procedure while at the same time not last all day. One of the many benefits of modern cosmetic procedures is that they are generally fast, and you can go back to work and activities shortly after. You would not want your face to be numb for the entire day.
Numbing Cream Interactions
Almost all drugs have some kind of interaction with other drugs, supplements, or excipients. One interesting interaction for BLT cream is benzoyl peroxide. This ingredient is especially common as an over-the-counter treatment for acne. When it is present on the skin prior to using BLT cream however, it significantly reduces the creams effectiveness, according to this published research.
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
