Understanding EMLA Cream and Its Uses
EMLA is a topical anesthetic cream that contains a eutectic mixture of two active ingredients: 2.5% lidocaine and 2.5% prilocaine [1.5.1]. This specific combination allows the anesthetics to exist as a liquid at room temperature, which enhances their penetration into the skin's epidermal and dermal layers [1.5.1, 1.5.2]. By blocking pain signals at the nerve endings, EMLA provides temporary numbness, or dermal analgesia, making it highly effective for reducing pain associated with various procedures [1.5.1, 1.5.4].
Common applications for EMLA cream include:
- Minor Skin Surgeries: Such as wart removal or other small excisions [1.5.3].
- Needle Insertions: Including vaccinations, blood draws, and the placement of IV catheters [1.5.4, 1.11.1]. It has been shown to be an effective pain-relieving strategy for childhood immunizations [1.11.1].
- Cosmetic Procedures: Commonly used before laser hair removal, tattoos, piercings, and microdermabrasion [1.2.1, 1.6.4].
- Genital Mucous Membranes: For superficial minor surgery or as a pretreatment for infiltration anesthesia [1.5.1].
Where Can I Buy EMLA Cream? Prescription vs. Over-the-Counter
The availability of EMLA cream depends on its formulation and local regulations. In many regions, including the UK and Canada, EMLA can be purchased over-the-counter (OTC) from pharmacies [1.4.2, 1.11.3, 1.11.4]. However, in the United States, EMLA itself is typically available only with a doctor's prescription [1.2.3, 1.5.3].
Prescription-Strength EMLA
Prescription versions, like EMLA, contain higher concentrations of active ingredients and are intended for medical procedures where deeper anesthesia is required [1.2.3]. These are obtained through a healthcare provider and dispensed by a pharmacy [1.2.1].
Over-the-Counter (OTC) Alternatives
While brand-name EMLA often requires a prescription, many OTC numbing creams containing lidocaine are widely available. These products usually have a maximum lidocaine concentration of 4% to 5% [1.2.1]. You can find these alternatives at:
- Local Pharmacies and Drugstores: Chains like CVS and others carry their own brands of lidocaine cream [1.9.2].
- Online Retailers: Websites like Amazon offer a wide variety of topical anesthetics [1.8.2].
- Beauty Supply Stores: Stores like Ulta may carry products suitable for cosmetic procedures [1.3.1].
It is crucial to be cautious when purchasing online. Ensure you are buying from a legitimate, registered pharmacy or a reputable retailer to avoid unlicensed or counterfeit products [1.4.2]. The FDA has issued warnings about certain OTC analgesic products that contain higher-than-permitted concentrations of lidocaine, which can pose serious health risks [1.2.5].
How to Apply EMLA Cream Correctly
Proper application is key to achieving the desired numbing effect.
- Plan Ahead: EMLA cream needs to be applied at least 60 minutes before the procedure on intact skin to become effective [1.6.2, 1.6.4]. For genital mucosa, the onset time is shorter, around 5 to 10 minutes [1.5.5].
- Apply a Thick Layer: Squeeze out a generous amount of cream onto the target area. Do not rub it in [1.6.2, 1.6.3]. A thick layer is necessary for the numbing agents to penetrate the skin effectively.
- Cover with a Dressing: Use an occlusive (air-tight, water-tight) dressing to cover the cream. This enhances absorption [1.6.1, 1.6.2]. For larger areas, plastic wrap can be used [1.6.3].
- Wait: Leave the cream and dressing in place for at least one hour, or as directed by your healthcare provider. The numbing effect reaches its maximum at 2 to 3 hours [1.7.2].
- Remove: Just before the procedure, remove the dressing and wipe off all the residual cream [1.6.2]. The skin will typically remain numb for 1 to 2 hours after the cream is removed [1.6.5, 1.7.2].
Important: Never apply EMLA to broken or irritated skin, open wounds, or near the eyes [1.6.5, 1.7.2].
Comparison of Topical Anesthetics
| Feature | EMLA Cream | Generic Lidocaine (OTC) | LMX4 |
|---|---|---|---|
| Active Ingredients | 2.5% Lidocaine & 2.5% Prilocaine [1.5.1] | Typically 4% or 5% Lidocaine [1.2.1, 1.9.4] | 4% Lidocaine (liposomal) [1.10.1] |
| Availability | Primarily prescription in the US [1.2.3, 1.5.3] | Over-the-counter [1.2.1] | Over-the-counter [1.9.4] |
| Onset Time | ~60 minutes on intact skin [1.6.2] | Varies, often around 20-30 minutes | Faster onset, effective in ~30 minutes [1.10.4] |
| Best For | Medically supervised procedures, vaccinations [1.5.4, 1.11.1] | Minor cosmetic procedures, mild pain [1.2.3, 1.9.2] | Procedures requiring rapid onset, debridement [1.10.1, 1.10.4] |
Studies comparing EMLA and LMX4 have found no statistically significant difference in pain management for procedures like sharp wound debridement, though some patients preferred LMX4 [1.10.1].
Potential Side Effects and Safety
While generally safe when used correctly, EMLA can cause side effects. Common, mild reactions at the application site include redness, swelling, paleness (blanching), and a burning or itching sensation [1.7.1, 1.7.4]. These effects are usually temporary and resolve within a couple of hours [1.7.4].
Serious side effects are rare but require immediate medical attention. These include:
- Allergic Reactions: Symptoms like hives, difficulty breathing, or swelling of the face, lips, tongue, or throat [1.7.3].
- Methemoglobinemia: A serious blood condition where the blood cannot carry enough oxygen. Signs include blue or pale skin, headache, dizziness, and shortness of breath [1.7.1, 1.7.3]. This risk is higher in infants under 6 months and individuals with certain health conditions [1.7.2].
- Systemic Toxicity: If too much cream is used or applied to a large area, it can be absorbed into the bloodstream and cause serious issues like irregular heartbeat, seizures, and breathing difficulties [1.2.5, 1.7.1].
Always use the smallest amount of cream necessary and follow the package insert or your doctor's instructions carefully. Do not use on children under 3 months without medical advice [1.6.5].
Conclusion
Determining where to buy EMLA cream depends largely on your location and the strength required. In the U.S., EMLA is a prescription product, but numerous effective over-the-counter alternatives containing lidocaine are available at pharmacies and online [1.2.3, 1.5.3, 1.9.2]. For any application, from vaccinations to tattoos, correct application—applying a thick layer under an occlusive dressing for at least an hour—is vital for effectiveness [1.6.2]. Always prioritize safety by purchasing from reputable sources, using the product as directed, and consulting a healthcare professional with any concerns.
For more information from the manufacturer in the UK, you may visit https://www.emla.co.uk/.
