Purpura caused by Emla is of toxic origin

Emla cream has been widely used as a local anaesthetic for superficial procedures. Blanching and redness are commonly observed side-effects. We observed purpura in 5 patients after application of Emla. Other authors have not reported this before. In 4 patients, purpura was observed after 30 min Emla application before the treatment of mollusca contagiosa. In 1 patient, Emla was used for 60 min before taking a lip biopsy. In these patients, patch tests were performed with the individual ingredients of Emla cream, Emla cream itself, placebo cream, and Tegaderm plaster. All tests were negative at an early reading after 30 min as well as after 2 and 3 days. We concluded that the purpuric reaction was not of an allergic nature. Possibly, it was caused by a toxic effect on the capillary endothelium.