Getting a new tattoo is exciting, especially if it's your first. Everyone warns you that getting a tattoo hurts, but what's a little temporary pain for a lifetime piece of body art, right? Spoiler: Getting a tattoo is typically more than a little pain, especially in areas where there is less flesh between skin and bone. In recent years, numbing creams have become popular for their use during and after getting a tattoo in order to ease the pain of the process.
There is a ton of information and advice on what to do and what not do when it comes to tattoos and it can be overwhelming to determine what advice is actually approved by a professional. Numbing creams may be available over-the-counter, but that does not mean that they are safe in all situations. It's important to understand what active ingredients are in the specific cream that you intend to use during or after your tattoo treatment, but there are some general dos and don'ts when it comes to numbing cream.
Meet the Expert
- Sarah Gee, MD, is a Harvard-trained board-certified dermatologist and the co-founder of Austin Skin.
- Morgan Rabach, MD, is a board-certified dermatologist and co-founder of LM Medical.
- Lindsey Zubritsky, MD, FAAD, is a board-certified dermatologist at Advanced Dermatology and Cosmetic Surgery.
In order to understand the safety and efficacy of numbing creams for tattoo recipients, we turned to three dermatologists for their expert advice. Keep reading for the complete guide to tattoo numbing creams.
What Are Numbing Creams?
Skin-numbing creams are topical anesthetic creams that can be applied to help to numb an area of skin. According to board-certified dermatologists Sarah Gee, MD, and Lindsey Zubritsky, MD, lidocaine is the most common ingredient found in numbing agents. "This topical anesthetic works to block sodium channels in our cells and prevent nerve transmission, which effectively reduces pain signals," explains Zubritsky. Compounded and prescription topical numbing agents also contain other anesthetics. When compounded and used in-office, Gee says lidocaine is often combined with benzocaine or tetracaine for maximal effect.
"For example, one of the most effective numbing creams is BLT cream, which contains 20 percent benzocaine, six percent lidocaine, and four percent tetracaine. These ingredients together are much stronger at anesthetizing than when used alone," she adds.
Numbing Creams for Tattoo Treatments
Tattoos are notoriously painful both during and after their application. It's easy to see why tattoo recipients might want to seek out numbing creams in the hopes of reducing their pain—but can they actually help? "Skin numbing creams can definitely help minimize the pain from tattoo treatment and I do recommend them," says Gee, but she adds two caveats: First, understand that the topicals will decrease but not eliminate pain. Second, opt for a prescription numbing cream applied in the office as they are most effective.
Zubritsky agrees. "Numbing cream is typically considered safe to apply before tattoo treatments, especially in areas that are particularly sensitive," she says. "However, the numbing cream may or may not be effective depending on the type of ingredients used. Furthermore, numbing cream starts to wear off as soon as it's wiped away, so it may not last the entire treatment duration."
Prescription Versus Over-the-Counter
There are many over-the-counter pain creams available, so what is the difference with prescription creams? The first and most obvious is the strength of the formulation. "The maximal lidocaine concentrations in over-the-counter formulations is four percent. The maximal lidocaine concentration in a prescription dispensed by physician for home application is five percent. Many dermatology offices acquire compounded topical lidocaine to help minimize procedural pain to 23% and they often combine it with tetracaine for maximal effect," explains Gee.
Zubritsky agrees and adds that prescription numbing creams are significantly more potent and effective. "These contain other ingredients or are compounded with stronger percentages of active anesthetics," she says.
Lidocaine alone as a topical agent (especially in low strengths) isn’t great for numbing for surgical procedures or tattoo treatments, shares Zubritsky. So why not just give the strongest possible numbing creams to patients to bring to their tattoo appointment? It's unfortunately not safe, shares Gee. "These are applied in the office so the patient can be monitored and it can be applied safety and properly. As the lidocaine percentage and body surface area of application goes up, so does the risk of toxicity so it is very important that these are used correctly," explains Gee.
How to Use Numbing Cream
It's important to use numbing creams properly in order to avoid any potentially dangerous side effects. These creams, if used correctly, can be great for numbing the skin before and after a tattoo, as well as before and after a laser tattoo removal. Our experts gave general advice for numbing creams, but all cautioned that directions can vary depending on the concentration and type of numbing agent used. No matter if you are planning on using over-the-counter or if you are hoping to get a prescription strength cream, you should consult your dermatologist to determine if numbing creams are right for you.
- Follow application instructions: Whether you use over-the-counter or prescription cream, it's important to read the dosage instructions. Board-certified dermatologist Morgan Rabach and Zubritsky add numbing cream should be used once a day.
- Give it time to take effect: The effects of numbing cream are not immediately felt. "Numbing cream is best applied 30-60 minutes prior to any procedure," explained Zubritsky. Rabach agrees and also recommends applying it about 30-60 minutes before you want it to work.
- Cover after application: Many numbing creams stop working once they are wiped off . If you're hoping to have it help with the pain of getting a new tattoo, you'll want to keep the cream on until the last minute before the tattoo artist needs to clean and prep the area. To do so, Rabach recommends covering the cream. "They take 30-60 mins to work, so it is best to put on ahead of time and then cover with an occlusive dressing or cellophane," she sayds.
- Don't apply with your fingers: This may seem fairly obvious, but numbing cream will numb whatever skin it comes into contact with so it's important to avoid getting it on any skin you do not need numbed. Zubritsky says a thin layer is all that's needed and it should always be used under the supervision of a physician using a glove or tongue depressor.
Potential Side Effects
With all the potential benefits of numbing creams, there are certain individuals who should not use them. "People with an allergy to lidocaine, people with a condition called methemoglobinemia, and people with certain cardiac conditions especially a 'heart block,'" cautions Gee. "Also, if you have severe liver disease, you will not be able to metabolize the medication properly, so it has to be avoided or used with extreme caution. They need to be used in caution in children."
There are some mild side effects that may accompany numbing cream use. The most common side effects include irritation, redness, skin discoloration, or mild burning, according to Zubritsky. Gee adds that side effects may also include ringing of the ears, lightheadedness, blurry vision and nausea. The main thing that is dangerous is using too much of the over-the-counter numbing creams because too much lidocaine can get absorbed into the bloodstream, explains Rabach. "There are reports of this mostly in people using numbing creams on large surface areas of the body—like numbing cream for legs before laser hair removal. But since tattoos can be large and take up large surface areas, this is applicable here too," Rabach shares.
When to Seek Medical Attention
While some side effects are mild, numbing creams can cause severe damage if used improperly. Severe toxicity includes seizures, hallucinations, and even death, cautions Gee. "Lidocaine toxicity at high doses can be fatal. If you are experiencing tingling of the mouth area and or any symptoms as listed above you need to seek immediate medical attention. In fact, many cases of tattoo removal and laser hair removal that have caused in severe disability and death do not involve the laser but rather lidocaine toxicity," shares Gee.
Side effects that may be indicative of numbing cream being absorbed systemically leading to lidocaine toxicity include irregular heartbeat, numbness or prickling around the mouth or tongue, dizziness, ringing in the ears, blurred vision, agitation or muscle twitching, says Zubritsky. Rabach agrees and adds that fast, slow, irregular heartbeat, passing out, dizziness and seizures, changes in mood or awareness, and changes in breathing are all symptoms that warrant evaluation by a doctor.