Pt RXN to Local Anesthtic... what's the deal?

[ElectraOnAzalea]

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I have a patient who breaks out in tiny little blisters around the site of local anesthetic infiltration. Usually, these blisters show up around 1-3 days after treatment and heal within a normal timeframe ~ 1 week. I have tried using different types of anesthetic to avoid the issue (lido w/ epi, polocaine, etc..) It happens every time. I've only noticed this around mx infiltrations, never when doing an IANB. Could it be some sort of manifestation of HSV or an allergic reaction? The blisters do not itch, are sort of painful when palpated (not excruciating), and the tissue around them looks red and inflamed. 😕

 

[Mackchops]

Does the patient have a hx of zoster? Sounds like its the herp. You could try premedicating with an antiviral if its very bothersome for the pt and see if that helps?

 

[monreal]

I have a patient who breaks out in tiny little blisters around the site of local anesthetic infiltration. Usually, these blisters show up around 1-3 days after treatment and heal within a normal timeframe ~ 1 week. I have tried using different types of anesthetic to avoid the issue (lido w/ epi, polocaine, etc..) It happens every time. I've only noticed this around mx infiltrations, never when doing an IANB. Could it be some sort of manifestation of HSV or an allergic reaction? The blisters do not itch, are sort of painful when palpated (not excruciating), and the tissue around them looks red and inflamed. 😕

Do you use topical? Try without or different.

 

[peg lateral]

Do you use topical? Try without or different.

I agree with this. I would try this first. I had a patient who gave me a hx of no allergies to anything, no meds, no anesthetic, no foods, etc. I put pina colada flavored topical on and my patient goes "Oh, I am allergic pineapple. That's not a big deal is it?" Well, the patient developed little red bumps where I had put the topical gel on. I switched to a different topical agent next time and there was not a problem.

If this does not solve the issue, I would definitely look into HSV.

 

[Streetwolf]

If it was topical then why no rxn to the IAN block? Unless the OP doesn't use topical with those...

 

[ElectraOnAzalea]

I use topical every time, even on IANB. We always have different flavors in the clinic and my patient has no hx of food allergy though. I'll try not using it next time and see what happens, but it is weird that it never happens with a mandibular block.

 

[Insipidipisin]

If it's HSV, is there some mechanism that allows for the dormant virus to become activated due to the ASA infiltration? I've seen this happen once before in a colleagues' patient.