Skin numbing creams such as Emla is licensed for topical anaesthesia before needle insertions for example before an injection, commonly used before children’s immunisations, or to numb the area before superficial skin procedures. Numbing creams became a popular choice for the off-license use as tattoo numbing creams. In this post, I will discuss over the counter availability of skin numbing creams and a numbing gel from the pharmacy, their age restrictions, and pricing. Always read patient information leaflet for detailed advice on methods of administration, special warnings, and other important information related to each numbing cream.
Skin numbing creams: the main active ingredients
Numbing creams available from the pharmacy contain local anaesthetic as the main active ingredient. Local anaesthetics used in topical anaesthetic creams include:
- Prilocaine (used together with lidocaine)
Topical anaesthetic creams temporarily block signals sent from the nerves located in the skin, which leads to numbing of the affected area. Numbing creams are generally effective at relieving pain, however, they require an early application before any procedure take place (Alster, 2013).
Where can you buy a skin numbing cream?
Numbing creams are licensed as pharmacy only medicines (P). P medicines are sold only in the pharmacy. Numbing creams are usually kept in the dispensary and not displayed to the public. This means that one needs to ask a member of staff to purchase one. When request is made, a pharmacist will most likely ask about the intended use for the cream. Topical anaesthetic creams can also be purchased also online from registered pharmacies.
What skin numbing creams can be purchased from the pharmacy?
- Emla numbing cream
- LMX4 numbing cream
- Ametop gel
- Denela cream
- Lidocaine ointment
- Lanacane cream
- Evo-10 numbing cream
1. Emla 5% skin numbing cream (2.5% lidocaine, 2.5% prilocaine)
Emla cream is the most popular numbing cream requested by the public and prescribed by GPs. Emla skin numbing cream is licensed for newborn infants 0-2 months and all other age groups of children and adults. EMLA cream should not be used at less than 37 weeks gestational age (eMC, 2019).
Emla cream is available as a individual 5g tube or as Emla OTC cream pack containing 5g tube and two occlusive dressings. Two dressings included in the OTC pack are 3M Tegaderm dressings (6 cm x 7 cm). Some pharmacies may be able to supply Tegaderm dressings separately when non-OTC Emla cream is purchased.
Individual Emla numbing cream is slightly cheaper than the OTC pack. The price will vary between pharmacies, but you should pay around £4 for individual numbing cream, and around £5 for the Emla OTC pack.
How and when to apply Emla cream?
- It is recommended to apply Emla cream at least 60 minutes before insertion of a needle. Check product information leaflet for applications before other procedures.
- ½ of the tube is applied to the area. Emla should not be rubbed in.
- Adhesive Tegaderm dressing should be applied to the area.
- The dressing should be left in place for at least 60 minutes.
- After 60 minutes (and a maximum of 5 hours, depending on the age), the dressing should be removed, and the area cleaned with alcohol before the procedure.
2. LMX4 skin numbing cream (4% lidocaine cream)
LMX4 contains lidocaine as the main active ingredient. LMX4 numbing cream is licensed for children over 1 month of age.
- LMX4 cream should be applied at least 30 minutes before skin procedure.
- LMX4 costs around £5 per 5g tube without dressing.
3. Ametop gel (4% Tetracaine)
Ametop is available in the gel formulation and comes in a 1.5g tube. Ametop is licensed for infants over 1 month of age, children and adults. Ametop numbing gel is not recommended for infants under 1 month of age.
Ametop gel should be applied 30-45 min before skin procedure. Longer applications are not necessary.
Ametop gel is kept in the fridge, although it may be stored for up to 1 month at 25°C before the use.
Ametop gel is cheaper than above numbing creams with a price of around £2 per tube (keep in mind Ametop’s smaller pack size).
4. Denela 5% Cream
Denela 5% cream contains the same active ingredients as Emla cream, namely 2.5% lidocaine, 2.5% prilocaine. Two versions of Denela % skin numbig cream exist:
- Denela 5% in 5g tube
- Denela 5% in 5g tube with two dressings
The price of Denela 5% cream is very close to Emla cream. You can purchase Denela 5% cream online, and almost certainly you would need to as a pharmacy staff to order one for you from the main wholesalers as Denela is not commonly prescribed in in the UK as compared to other anaesthetic creams such as Emla.
Denela cream is licensed for babies from 38 weeks old and adults. The directions for application of the cream vary between indicated use, therefore please refer to the product information leaflet for more details.
5. Lidocaine 5% Ointment
Although not a cream, I want to include Lidocaine 5% ointment as it can be used as a skin numbing product. Lidocaine 5% ointment is a pharmacy-only medicine, which is kept in the dispensary of the pharmacy, therefore a request needs to be made to purchase it over the counter.
Lidocaine 5% ointment is licensed for as numbing product to:
- help to numb the skin
- to numb the gums in dentistry
- to relieve the pain caused by different conditions including anal fissures (a small tear)
- to relieve in of sore nipples in mothers who breastfeed
There are no specific age restrictions for the use of Lidocaine 5% ointment. Lidocaine ointment can be used by the elderly, adults and children
6. Lanacane Skin Numbing Cream (benzocaine 3% cream)
Lanacance cream contains benzocaine as an active ingredient. Although benzocaine is classified as a local anaesthetic, the licensed use of Lanacane cream differs from previously discussed numbing creams. Lanacane is licensed to:
- relief pain, itching, and irritation due to insect bites, skin irritation for example due to nettle stings. Read more about ointments or creams for insect bites.
- relief itchiness of the external genital and anal area
Lanacane is a General Sales Licence (GSL) product. It can be purchased in any shop or most likely in a supermarket or a pharmacy. You can purchase Lanacane online. Lanacane is licensed for adults and children from 12 years of age.
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7. Evo-10 skin numbing cream (lidocaine 10% cream)
Evolution 10 (Evo-10) is the only numbing cream that can be purchased ‘over the counter’, mainly online. Evo-10 contain lidocaine 10%, a local anaesthetic.
Evo-10 can be used to numb the skin before:
- Hair removal
- Needle Procedures (tattooing)
Skin numbing creams: common side effects
Common side effects associated with the use of local anaesthetic creams (excluding Lanacane) include:
- skin irritation
- redness at the application site
- swelling at the application site
The experience of side effects differs and depends on the area of the treatment.
What is the best skin numbing cream?
A systemic review of 25 randomised controlled trials (over 2000 patients) concluded that Emla cream may be effective as non-invasive topical anaesthesia. This research paper also concluded that other numbing products such as LMX and Ametop are as effective (Eidelman et al, 2005).
Can you use a skin numbing cream before children’s immunisations?
Topical numbing creams can be used before children’s vaccinations. Numbing cream will decrease the pain of needle insertion but will not take the pain completely away.
Can you buy skin numbing cream for a tattoo procedure or piercing?
Licensed use of all above numbing products is associated with medical procedures. Customers requesting numbing creams for applications before the tattoo or piercing procedures will most likely be refused the sale as this is an unlicensed use of the product.
Skin numbing creams: FAQ
Can I buy EMLA cream over the counter?
Yes. You can buy EMLA cream over the counter. EMLA cream is a pharmacy only medication meaning it can only be bought from a registered pharmacy (conventional or online).
How much does EMLA cream cost?
EMLA cream costs around £4.50 for 5g tube. OTC EMLA pack (comes with two dressings) cost around £5. Prices may vary between pharmacies.
Can EMLA be used on broken skin?
Product information states that EMLA Cream is applied to intact skin under an occlusive dressing.
How long do you leave lidocaine cream on?
EMLA cream should be applied 60 minutes before needle insertion. LMX4 cream (4% lidocaine) should be applied at least 30 minutes before skin procedure. Read the product information leaflet for more details.
Alster Tina (2013). Review of Lidocaine/Tetracaine Cream as a Topical Anesthetic for Dermatologic Laser Procedures. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107876/ Accessed on 16/07/2019
Eidelman Anthony (2005). Topical Anesthetics for Dermal Instrumentation: A Systematic Review of Randomized, Controlled Trials. Annals of Emergency Medicine, Volume 46, Issue 4, 343 – 351 Available at: https://doi.org/10.1016/j.annemergmed.2005.01.028 Accessed on 17/07/2019
eMC (2019). SmPC: Emla cream. Available at: https://www.medicines.org.uk/emc/product/871/smpc Accessed on 17/07/2019