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.

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