Minimizing Pain and Distress During Dermatologic Procedures

Conclusions

• Painful dermatologic procedures can be made much more tolerable by combining analgesia, anxiolysis, and distraction rather than relying on restraint or speed alone.
• Early and effective pain control matters because procedural pain can amplify later pain sensitivity and create longer-term distress.
• Skin-to-skin contact, breastfeeding, and sucrose are strong, low-cost analgesic strategies for infants.
• Topical anesthetics are safe and effective when given enough time to work, with EMLA, tetracaine, and newer liposomal formulations providing useful options.
• Cryotherapy pain can often be reduced by applying topical anesthetic immediately after freezing, and cooling itself can meaningfully reduce discomfort.
• For injectable local anesthesia, warming the solution, using smaller needles, injecting slowly and deeply, and buffering lidocaine all reduce pain.
• Simple additives such as benzyl alcohol-containing saline and skin cooling may further lessen injection discomfort and can be combined with lidocaine.
• Cooling and vibration together can reduce pain more effectively than either alone and may even improve procedural success such as venipuncture.
• Active distraction works better than passive distraction, and interactive tablet or game-based methods can outperform sedative medication for some children.
• Clear, reassuring language and careful holding techniques can reduce fear and procedural distress, especially in young children.
• A calm environment plus practical nonpharmacologic tools can greatly improve the experience for patients, parents, and clinicians.
• Some integrative approaches, including pleasant odors or aromatherapy, may help reduce pain responses, but these are still more exploratory than core techniques.