Histopathology of an adverse reaction to a eutectic mixture of the local anesthetics lidocaine and prilocaine

A unique histopathologic reaction to the topical application of a eutectic mixture of the local anesthetics lidocaine and prilocaine (EMLA), used for topical anesthesia prior to biopsy in two children is described. Standard a pplication of EMLA cream under occlusion for 1 h was given to both patients . The biopsies in both cases demonstrate focal vacuolization of the upper s pinous and granular layers. The epidermis was focally separated from the de rmis in areas of basal vacuolar alteration. Electron microscopy performed i n one case demonstrated the dermal-epidermal cleft to be secondary to alter ation of the basal cells with condensation of the cytoplasm and cytologic d egeneration similar to that seen in epidermolysis bullosa simplex.