Topical Anesthetic

What is a topical anesthetic?

A topical anesthetic is a type of local anesthetic that temporarily numbs the area to which you or a healthcare provider apply it. It provides symptom relief by reducing pain and itchiness (pruritus) in an area. Topical means you spread it on a surface — it’s not an injection.

Topical anesthetics can be for your skin or mucosa, including:

• Your mouth and gums.
• Inside your nose, throat and ears.
• The conjunctiva of your eyes.
• Your rectum and vagina.

These anesthetics come in various forms, like:

• Creams.
• Ear drops.
• Eye drops.
• Gels.
• Lotions.
• Ointments.
• Patches.
• Solutions (liquids).
• Sprays.

What are the types of topical anesthetics?

There are over-the-counter (OTC) topical anesthetics that you can buy and forms that healthcare providers use for certain minor procedures.

Types of topical anesthetics include:

• Benzocaine.
• Dibucaine.
• Lidocaine.
• Phenol.
• Pramoxine.
• Prilocaine.

Each of these medications comes in several forms for a variety of uses. They’re often combined with other medications and active ingredients (like hydrocortisone, menthol or methyl salicylate) depending on their intended use.

What can you use topical anesthetics for?

Topical anesthetics have several purposes. You may use them at home, or healthcare providers may use them to numb your skin or mucosa for a variety of reasons.

At-home uses for topical anesthetics

Examples of at-home use of over-the-counter topical anesthetics include relieving pain and/or itchiness for:

• Insect bites and stings, like ant bites, mosquito bites and bee stings.
• Minor heat burns and sunburn.
• Minor cuts.
• Skin rashes from poison ivy, poison oak and poison sumac.
• Hemorrhoids.
• Sore throat.
• Canker sores.
• Vaginal yeast infections.

It’s important to remember that topical anesthetics don’t treat or cure any health issues. They can only help with symptoms. Some of these health conditions, like severe rashes and yeast infections, may require medical treatment from a healthcare provider.

Medical uses for topical anesthetics

Healthcare providers use topical anesthetics for various medical purposes and procedures. Sometimes, it’s the only type of anesthetic they use, and other times they apply it before a local anesthetic injection.

Skin applications include:

• To minimize discomfort before injections (like vaccines) or inserting IV (intravenous) and arterial lines.
• To relieve pain before minor dermatologic and laser procedures, like laser hair removal, tattoo removal, and shave or excision biopsies.
• For minor penile surgery, like circumcision, meatotomy and removal of genital warts.
• To alleviate the symptoms of certain causes of chronic pain, like myofascial trigger points and trigeminal neuralgia.

Eye applications include:

• To numb the outside of your eye for certain procedures or tests, like a Schirmer’s test, minor laser surgeries and intravitreal injection.

Mouth and throat applications include:

• To numb your gums before giving a local anesthetic injection for dental procedures.
• To numb your mouth and throat for awake fiberoptic intubation or laryngoscopy.
• To minimize pain for incision and drainage of abscesses.

Inner ear applications (on the tympanic membrane, or eardrum) can provide pain relief for:

• Tympanocentesis (removal of fluid from behind your eardrum).
• Myringotomy.
• Ear tube (tympanostomy) placement, removal or manipulation.

Nose and nasal cavity applications include:

• To numb your nasal cavity for examination using rigid or flexible endoscopes.
• To help control a nosebleed (epistaxis).
• To provide pain relief for nasal fractures.

How do topical anesthetics work?

Topical anesthetics work by blocking signals in nerve endings in your skin or mucosa. This temporarily blocks sensations — like pain, touch and itchiness — in a limited area. Topical anesthetics are superficial, which means they only provide numbness for the upper layers of your skin and mucosa.

How should I use topical anesthetics?

Talk to your healthcare provider and carefully read the instructions for OTC topical anesthetics before using them. The packaging will give you instructions on where to use the product and how much and how often to apply it.

If you’re going to use a topical anesthetic on your child, make sure they’re old enough per the guidelines on the packaging. Once you apply it to your child’s skin, make sure they don’t get any of it in their mouth. Topical anesthetics can cause serious side effects if they get in your mouth or you swallow them, especially in children.

When you’re not using a topical anesthetic, store it safely away from children and pets.

What are the side effects of topical anesthetics?

Because there are several types of topical anesthetics — and they can be combined with other medications and active ingredients — there’s a wide range of possible side effects. If you’re using an over-the-counter (OTC) topical anesthetic, read the packaging to learn about the possible side effects to look out for.

Topical anesthetics are generally safe. Side effects mainly happen if you use (absorb) too much of the medication or ingest it. Be sure to follow the instructions for OTC topical anesthetics so you use them properly.

Side effects may include:

• Blurred or double vision.
• Ringing in your ears (tinnitus).
• Metallic taste in your mouth.
• Dizziness.
• Drowsiness.
• Increased heart rate (tachycardia) or irregular heartbeat (arrhythmia).
• Headache.
• Fatigue.
• Agitation or confusion.
• Muscle twitching.
• Seizures.

Allergic reactions

While rare, it’s possible to develop an allergic reaction to a topical anesthetic. Symptoms of an allergic reaction include:

• Skin redness or discoloration that spreads beyond the affected area.
• Very itchy skin.
• Hives.
• Swelling.

Minor allergic reactions typically go away on their own with time. Be sure to stop using the medication that caused it. If these symptoms continue to get worse, talk to your healthcare provider.

Signs of a severe allergic reaction (anaphylaxis) include:

• Swelling of your lips, tongue or throat.
• Shortness of breath (dyspnea), trouble breathing or wheezing.
• Dizziness and/or fainting.
• Stomach pain, vomiting or diarrhea.
• A feeling of panic.

Anaphylaxis requires immediate medical attention. Call 911 or your local emergency services number, or go to the nearest hospital.

When should I see my healthcare provider if I’m using a topical anesthetic?

See your healthcare provider if:

• The condition you’re using the medication for doesn’t get better in seven days, or it gets worse.
• You develop a skin infection.
• You swallow any of the medication.

A note from Cleveland Clinic

Topical anesthetics can provide temporary pain and itch relief on your skin and mucosa. They can be helpful for minor nuisances like bug bites and mild rashes. Like all medications, it’s important to read the instructions carefully. If you develop any side effects or the condition you’re using the anesthetic for doesn’t get better, talk to your healthcare provider. You may need medical treatment.