When You Use EMLA^®, Tell Your Pathologist

EMLA, eutectic mixture of lidocaine and prilocaine in an oil-and-water emulsion, is used as topical anesthetic by itself or to decrease discomfort associated with injection of local anesthesia. Frequently used in children, it is also utilized during minor procedures in the vulva (e.g., cautery of genital warts). Clinical reactions to this anesthetic include local vascular reactions (e.g., petechia and necrosis), urticaria, and irritant contact dermatitis.

These authors reviewed the cases of three post-menopausal patients who underwent biopsy for the differential diagnosis of erosive lichen planus and lichen sclerosus. Pre-procedural manifestations included discomfort, pruritus, and architectural changes of the vulva. No oral or vaginal lesio…