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| |  Improved Pain Relief for the Treatment of Genital Warts SCHAUMBURG, Ill. -- August 27, 1997 -- Genital warts, caused by the human papilloma-virus, are the most prevalent of sexually transmitted viral diseases. An estimated 12 million Americans may suffer from this infection. Both men and women are afflicted. Surgical procedures used to remove genital warts include excision, laser, cryotherapy (freezing) and electrodesiccation (electric needle). All are admittedly painful. Recently, EMLA cream, a topical anesthetic cream has been proven to significantly reduce the pain of treatment. In the July issue of the Journal of the American Academy of Dermatology, Alan Menter, M.D., Chief Division of Dermatology, Baylor University Medical Center, Dallas, reported on a study exploring the use of the lidocaine/prilocaine cream to eliminate the pain associated with the removal of genital warts. Typically, to reduce the discomfort of surgery, a prior lidocaine injection of anesthesia is administered in the locale of the wart. Unfortunately, the injection can also be painful. "A further disadvantage is the pain associated with cryotherapy and the inability to treat thoroughly the first time. There is a 30% recurrence rate. That is why there is such an important need for pain relief in order to facilitate total treatment," explained Dr. Menter. The purpose of the study was to determine the effect of topically applied lidocaine/prilocaine cream, to reduce both the pain of the lidocaine shot and the pain associated with cryotherapy to remove genital warts. Men scheduled for cryotherapy genital wart removal were randomly selected to receive one of three treatments: (1) lidocaine/prilocaine cream application followed by cryotherapy, (2) 1% lidocaine injection followed by cryotherapy, and (3) lidocaine/prilocaine cream application, followed by injection of 1% lidocaine, followed by cryotherapy. A total of 121 men took part in the study. No other form of pain medication was allowed three days prior to treatment, and no alcohol was ingested within 12 hours before surgery. The recommended application time for topical lidocaine/prilocaine cream on normal intact skin is 60 minutes. Because of the thinness of penile skin and the increased penetration under occlusion, an application time of 15 minutes was chosen. The results showed that the application of the lidocaine/prilocaine cream markedly reduced the pain of the lidocaine local anesthesia injection. Further, the combination of the cream with the 1% lidocation injection gave even greater relief from the cryotherapy than did either anesthetic alone. "This combination of treatments appears to act synergistically. This combination anesthetic technique may possibly allow a more complete freezing of genital warts in a more cooperative patient. Likewise, patients will be more likely to come back for any necessary additional treatments if they are reassured of pain relief," Dr. Menter said. The American Academy of Dermatology is the largest medical society representing physicians who specialize in treating skin, hair and nail conditions.
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