Myiasis is a parasitic infestation caused by dipterous larvae and is an important diagnostic consideration in travellers returning from endemic regions with infected skin lesions. Paediatric cases present unique management challenges, particularly when invasive procedures or general anaesthesia are considered. We report a case of cutaneous myiasis with associated cellulitis in a toddler following travel to Gambia, caused by Cordylobia anthropophaga (tumbu fly). A novel non-operative approach using eutectic mixture of local anaesthetic cream was successfully employed to facilitate larval extraction, avoiding the need for surgical intervention. This case highlights a safe, effective and minimally invasive technique for managing paediatric cutaneous myiasis in an emergency department setting.

Background: Application of the capsaicin 8% patch is commonly associated with treatment-related burning pain, which may necessitate rescue analgesia, compromise completion of the standardized 60 min application, and reduce acceptance of repeat treatment. Although capsaicin is an established therapy for painful diabetic peripheral neuropathy (PDPN), evidence supporting strategies to improve procedural tolerability remains limited. This study evaluated whether ultrasound-guided bilateral ankle nerve block (UGBANB) was associated with better procedural outcomes than topical eutectic mixture of lidocaine/prilocaine (EMLA) pretreatment or no pretreatment. Methods: This retrospective comparative cohort study included 90 adults with neurologist-confirmed PDPN who underwent capsaicin 8% patch therapy. Patients received no pretreatment (n = 30), topical EMLA pretreatment (n = 30), or UGBANB (n = 30). The primary outcome was cumulative procedural pain burden, quantified as the area under the Numeric Pain Rating Scale-time curve (AUC-NPRS) during the standardized 60 min application. Secondary outcomes included rescue tramadol requirements, treatment completion, early postprocedural pain intensity, procedural tolerability, willingness to undergo repeat treatment, and safety. Results: Cumulative procedural pain burden differed significantly among the three pretreatment strategies (one-way ANOVA: F = 289.8, p < 0.001; η[2] = 0.87). Mean AUC-NPRS was 481.5 ± 39.2 NPRS·min with no pretreatment, 429.2 ± 36.0 with topical EMLA, and 256.3 ± 38.4 with UGBANB, corresponding to approximately 47% and 40% lower cumulative pain burden with UGBANB than with no pretreatment and topical EMLA, respectively. No patient receiving UGBANB required intravenous rescue tramadol, compared with 60.0% receiving EMLA and 100.0% receiving no pretreatment (p < 0.001). Treatment completion was 100% with UGBANB, compared with 83.3% with EMLA and 73.3% with no pretreatment. UGBANB was also associated with lower early postprocedural pain, greater procedural tolerability, and greater willingness to undergo repeat treatment. No serious treatment- or block-related adverse events were observed during the available follow-up. Conclusions: UGBANB was associated with better procedural tolerability and treatment delivery during capsaicin 8% patch therapy than topical EMLA or no pretreatment in patients with PDPN. These findings relate specifically to procedural optimization and should not be interpreted as evidence that UGBANB enhances the intrinsic or long-term analgesic efficacy of capsaicin. Prospective multicenter randomized controlled trials are needed to confirm these associations and determine whether improved procedural tolerability translates into better long-term treatment adherence, clinical outcomes, health-related quality of life, safety, and cost-effectiveness.

Background: Lidocaine and prilocaine cream is a compounded topical anesthetic formulation comprising lidocaine and prilocaine. Upon application, the active ingredients are locally released and permeate into the subcutaneous tissue, exerting anesthetic effects by blocking ion channels involved in nerve impulse transmission. Variations in drug permeation may influence the onset time, anesthetic efficacy, and duration of action. Methods: This study investigates the in vitro properties of the innovator formulation Emla® and five generic formulations through in vitro bioequivalence studies and Q3 Characterization tests. Results: With the exception of TS, the generic formulations exhibited notable differences compared to the innovator product. Specifically, TB and TL demonstrated significantly higher in vitro release than Emla®, yet exhibited lower in vitro permeation rates. In contrast, TH and TT showed release rates comparable to Emla®, while their permeation rates were similarly reduced. Conclusions: These findings indicate that in vitro release rate does not directly predict in vitro permeation. Permeation behavior is significantly influenced by emulsion globule size, rheological characteristics (viscosity and elasticity), and pH, collectively underscoring the multifactorial nature of this phenomenon.

Background: Effective topical anesthesia is essential to patient comfort and adherence during minimally invasive esthetic procedures. We retrospectively reviewed pain scores recorded after microneedling in a single private clinic where two topical anesthetic formulations-lidocaine 7%/tetracaine 7% (Pliaglis) and lidocaine 2.5%/prilocaine 2.5% (Anesderm)-were used as part of standard clinical practice on different anatomical sites and under different application protocols. Methods: Records were reviewed from 26 healthy female patients (mean age 42 ± 4 years; range 34-48) who underwent microneedling on the face and neck during 2024 in a single private clinic. According to the established clinic protocol, which was not modified for research purposes, Pliaglis was applied to the face without additional occlusion (self-occlusive peel-off film, in accordance with the manufacturer's recommendation) and Anesderm was applied to the neck under plastic-film occlusion (also in accordance with the manufacturer's recommendation), both for 45 min prior to microneedling at a fixed depth of 1.25 mm. Treatment allocation was determined by clinic workflow; patients and the operator were not blinded, and the order of the two products within each session was not randomized. Post-procedural pain was recorded using a Visual Analog Scale (VAS, 0-10), with one decimal precision, separately for each anatomical site. Within-patient differences were analyzed using a paired-sample t-test, with a Wilcoxon signed-rank test as a non-parametric sensitivity analysis. Results: Pain scores were lower at the facial site (Pliaglis, no occlusion) than at the cervical site (Anesderm, occlusion): mean VAS 3.00 ± 0.63 vs. 5.38 ± 0.75; mean within-patient difference 2.38 points, 95% CI 1.97-2.80; paired t(25) = 11.87, p < 0.0001; Cohen's d = 2.33. The Wilcoxon signed-rank test produced a concordant result (p < 0.0001). A within-patient pain reduction of at least 30% on the facial site relative to the cervical site was observed in 81% of patients (21/26). Both products were well tolerated, with only mild transient erythema reported. Conclusions: In this retrospective, non-randomized, non-blinded single-center analysis, lower pain scores were observed at the facial site (treated with lidocaine-tetracaine 7%/7% without additional occlusion, per manufacturer instructions) than at the cervical site (treated with lidocaine-prilocaine 2.5%/2.5% under occlusion, per manufacturer instructions) within the same patients. Because formulation, active-drug concentration, anatomical site, and the manufacturer-mandated occlusion technique co-varied between the two conditions, the observed difference cannot be attributed to formulation alone. These findings should be regarded as hypothesis-generating and require confirmation in prospective, randomized, split-region or split-face studies that disentangle formulation effects from site- and protocol-related factors.

This study aimed to determine whether microneedles (MN) can enhance the efficacy of a commercially available topical anesthetic (EMLA®) when applied to the palatal mucosa. In a randomized, double-blind, crossover trial, 30 male volunteers received bilateral applications of MN patches and flat patches (FL, without MN) on the palatal mucosa. EMLA® was subsequently applied for either 2 or 5 min in separate sessions. Immediately thereafter, infiltrative anesthesia was administered, and pain intensity associated with needle insertion and local anesthetic injection was measured using a 0-100 Visual Analogue Scale. No differences in pain intensity were observed during needle insertion or local anesthetic injection when MN and FL patches were compared, irrespective of the duration of EMLA® application. However, a significantly higher proportion of participants reported pain-free infiltrative anesthesia when EMLA® was applied for 2 min following MN pretreatment (40%) compared with FL pretreatment (10%) (p = 0.008). MN application was not associated with adverse effects. Pretreatment with MN enhances the clinical efficacy of intraoral topical anesthesia in males. These findings open new avenues for exploration of advanced transbuccal drug delivery technologies focused on fast-release systems that may improve clinical outcomes in topical dental anesthesia.

Pain and anxiety during dental local anesthesia injections remain a significant challenge in pediatric dentistry, often leading to fear, poor cooperation, and negative treatment experiences in children. Therefore, it is of interest to compare the effectiveness of transcutaneous electric nerve stimulation (TENS), EMLA cream as well as conventional lignocaine topical spray, in conjunction with needles that were 25- gauge and 30-gauge for relieving anxiety and pain in children's during dental local anesthesia administration. Around 180 children ranging from 8 to 12 years old were randomly divided into six groups of equal size (n=30 for each group). The pain was evaluated via FLACC and VAS while anxiety was assessed with the Venham's Anxiety Scale along with pulse rate. The least anxiety and pain outcomes were found for the TENS + 30 gauge group, which demonstrated the longest-lasting pulse response and also the lowest score on FLACC and VAS (p less than 0.05). EMLA 30 gauge also showed less pain when compared to sprays applied to the skin, but were lower than TENS. Thus, we show using TENS that has a needle of a fine gauge as a safe, effective aid to improve the comfort of local anesthetic administration.