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Use of Nitrous Oxide in Dermatology

A Systematic Review

Brotzman, Erica A. DO*; Sandoval, Laura F. DO*,†; Crane, Jonathan DO*,†,‡

doi: 10.1097/DSS.0000000000001464
Review Article

BACKGROUND Many dermatologic procedures are painful and can be distressing to patients.

OBJECTIVE To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures.

METHODS A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology.

RESULTS Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures.

CONCLUSION Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.

*Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina;

Department of Dermatology, Sampson Regional Medical Center, Clinton, North Carolina;

DermOne, Wilmington, North Carolina

Address correspondence and reprint requests to: Laura F. Sandoval, DO, Department of Dermatology, Sampson Regional Medical Center, 1099 Medical Center Drive, Wilmington, NC 28401, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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