Description:
<jats:title>Summary</jats:title><jats:p>While treating a 63‐year‐old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material.After topical anesthesia with a lidocaine‐prilocaine mixture (EMLA<jats:sup>®</jats:sup> cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application.The area turned necrotic over days and the center was débrid‐ed.</jats:p><jats:p>A more detailed history revealed that similar necrosis had occurred previously when EMLA<jats:sup>®</jats:sup> cream had been employed.We interpreted the current event,as well as the past episodes,as a pathological reaction of the small cutaneous blood vessels to EMLA<jats:sup>®</jats:sup> cream. The history also revealed an overlap connective tissue disease with microvascular impairment.</jats:p><jats:p>After exposure to the topical anesthetics, the pre‐damaged cutaneous blood vessels presumably produced a critical ischemia with subsequent necrosis. Based on this case, we recommend careful use of EMLA<jats:sup>®</jats:sup> cream with frequent monitoring for necrosis when treating patients with a known disorder of microcirculation.</jats:p>