EMLA for laser treatment of portwine stains in children

Vascular-specific lasers with pulse durations of between 300 and 500 microseconds are the treatment of choice for portwine stains (PWS), particularly in children. Although the discomfort felt following laser irradiation from a single pulse is transient, these sensations are intensified when multiple pulses are delivered over a confined area of skin. Because 75-80% of PWS are located in the head and neck regions, laser treatment of these sites tends to be more painful than those located in most other parts of the body. A prospective double blind randomized study, assessing pain during laser irradiation on PWS skin occluded with either EMLA, placebo, or no cream (control) was performed in 73 PWS subjects between 5 and 16 years of age. Analysis of the data showed that the pain scores for EMLA-treated sites were the smallest, the control scores tended to be the highest, with the placebo scores in the middle. The differences between the treatments were significant (P < 0.0001).