Decreasing the pain of dermatologic procedures in children

Dermatologic procedures in children can range from simple paring of warts to laser surgery and complex excisions with repair. These procedures may be more challenging to perform in children because of increased fear, anxiety, and pain perception. The approach to dermatologic procedures should be tailored to the age and individual needs of each child. Honest but unthreatening explanations of the procedure, distraction techniques, and postoperative praise and rewards can be very helpful. Topical anesthetic such as EMLA (eutectic mixture of local anesthetics) cream and benzocaine gel can help to decrease the pain of procedures. Buffering and warming lidocaine before infiltration is recommended. Physicians should be aware of the benefits and risks of preoperative analgesics and sedatives and of applicable guidelines for their appropriate use. For more painful procedures, larger procedures, or surgical procedures in young children, general anesthetics may be appropriate. Risks and benefits of the use of general anesthetics in the pediatric population are reviewed with specific emphasis on issues specific to pulsed-dye laser in children. Knowledge of techniques used to decrease the pain and anxiety of procedures can assist in making them a better experience for children, families, and physicians.