What is the difference between BLT and EMLA cream?

EMLA is a commercially manufactured 1:1 eutectic mixture of Lidocaine 2.5% and Prilocaine 2.5% — total anesthetic concentration approximately 5%. BLT cream is a compounded formulation containing Benzocaine 20%, Lidocaine 10%, and Tetracaine 10% — total anesthetic concentration approximately 40%. The clinical implications: BLT has a faster onset (about 15 minutes vs 30 to 60 minutes for EMLA), greater depth of penetration, and longer duration. EMLA is approved for use on intact skin in children and adults and is available over the counter in some jurisdictions. BLT, because of its high concentration, is restricted to licensed providers.

Can BLT cream be used before tattooing or permanent makeup?

MediCaine is sold exclusively to licensed medical and aesthetic providers. Within that scope, licensed providers performing tattoo removal, scar revision tattooing, paramedical tattooing, areola repigmentation, and permanent makeup procedures under medical supervision commonly use BLT cream as a pre-procedure topical anesthetic. Apply 30 minutes before the procedure, cover with occlusion for deeper penetration into the dermal layer, and remove completely before tattoo work begins. Tetracaine's deep tissue penetration is particularly valuable for procedures that breach the epidermal-dermal junction. Always follow your state board's rules on topical anesthetic use in non-medical tattoo settings.

COMPOUND TOPICAL ANESTHETIC

BLT CREAM — 20 / 10 / 10

Q: How long does BLT cream last?

Standard BLT cream (20/10/10) provides clinical anesthesia for approximately 2 to 4 hours after onset, with peak effect at 30 to 45 minutes after application. With Phenylephrine added as a vasoconstrictor, duration can extend toward the upper end of that range because the vasoconstriction slows systemic absorption and keeps the anesthetic concentrated at the treatment site. Quad-agent BLT+ formulations that add Prilocaine can extend duration to 4 to 5 hours, suitable for longer aesthetic and dermatologic procedures.

Q: How long before treatment should BLT cream be applied?

Apply BLT cream 15 to 25 minutes before the procedure for most applications. For superficial procedures such as Botox, dermal fillers, and IV access, 15 minutes is typically sufficient. For deeper procedures such as microneedling, laser hair removal, biopsies, and dermal resurfacing, 20 to 30 minutes is recommended. Apply a generous, even layer to the treatment area, then cover with plastic film (occlusion) for procedures requiring deep penetration. Without occlusion, allow an additional 5 to 10 minutes of contact time.

Q: How much BLT cream should be used?

Use the smallest amount that delivers full anesthesia of the target area, generally 1 to 2 grams of BLT cream per 10 by 10 cm of skin. Maximum safe single-use dose for a healthy adult is approximately 30 grams of standard 20/10/10 BLT applied to intact skin without occlusion. Never exceed the maximum dose, never apply to broken, inflamed, or irritated skin without provider judgment, and always remove residual cream before the procedure begins. Pediatric, elderly, hepatic, and cardiac patients require dose reduction and provider discretion.

Q: What procedures use BLT cream?

BLT cream is used across multiple specialties: dermatology (biopsies, cryotherapy, laser resurfacing, Mohs micrographic surgery, ablative laser, electrosurgery, mole removal), dentistry (pre-injection numbing, scaling and root planing, crown preparation, mucogingival surgery), aesthetic medicine (dermal fillers, Botox, lip augmentation, microneedling, RF microneedling, chemical peels), laser treatments (laser hair removal, laser tattoo removal, IPL, fractional laser), and minor surgical procedures (skin tag removal, ingrown toenail care, sebaceous cyst excision). Tier selection depends on procedure depth and required duration.

Q: Is BLT cream FDA approved?

The individual active ingredients in BLT cream — Benzocaine, Lidocaine, and Tetracaine — are FDA-approved local anesthetics. The combined BLT cream itself is a compounded preparation prepared by a licensed 503A compounding pharmacy under USP 795 standards on a per-prescription basis for a specific patient or provider. Compounded medications are not FDA-approved as finished products in the same way mass-manufactured drugs are; instead they are regulated by state boards of pharmacy and the FDA's compounding rules. MediCaine compounds BLT in a USP 795 compliant facility and ships exclusively to NPI-verified licensed providers.

Q: Can BLT cream be used before microneedling?

Yes. BLT cream is the most common pre-procedure topical anesthetic for medical microneedling and RF microneedling (such as Morpheus8, Vivace, Genius). Apply a thick layer of BLT to the treatment area 20 to 30 minutes before the procedure. The cream must be completely removed and the skin thoroughly cleaned with alcohol or saline before the microneedling device touches the skin — this prevents the anesthetic from being driven into the dermal micro-channels and reduces the risk of systemic absorption. For standard microneedling at 0.5 to 1.0 mm, MediCaine Pro provides excellent coverage; for aggressive RF microneedling at 1.5 to 4.0 mm, step up to MediCaine Ultra.

The triple-agent compound used by dermatologists, dentists, aesthetic injectors, and med spas. Benzocaine 20% + Lidocaine 10% + Tetracaine 10%. 15-minute onset. 2 to 4 hour duration. Compounded fresh per order in the USA. For licensed providers.

Order BLT Now Talk to a Pharmacist

503A Compounding Pharmacy NPI-Verified Providers USP 795 Compliant Compounded Fresh Per Order

WHAT IS BLT CREAM

THREE ANESTHETIC AGENTS. ONE COMPOUND.

BLT cream is the shorthand name for a compounded topical anesthetic that combines three local anesthetic agents — Benzocaine, Lidocaine, and Tetracaine — into a single multi-agent formulation. The classic concentration is written as 20/10/10: Benzocaine 20%, Lidocaine 10%, and Tetracaine 10%. Total active anesthetic load is approximately 40%, about eight times the concentration of consumer-grade single-agent products.

The three agents work in series rather than parallel. Benzocaine penetrates the outer epidermis fast — it is responsible for the early numbing sensation patients feel within 5 to 10 minutes. Lidocaine reaches the deeper dermal layer and provides the main bulk of the anesthesia. Tetracaine is the most potent of the three and the slowest to onset; it penetrates deepest, lasts longest, and maintains anesthesia after the cream is removed. Together they cover the full pain pathway from surface to deep dermis.

Many BLT formulations — including MediCaine Pro — add Phenylephrine 0.5% as a vasoconstrictor. Phenylephrine narrows the cutaneous blood vessels at the application site, which slows systemic absorption of the anesthetic and keeps it concentrated in the treatment area. The net effect is faster perceived onset, longer duration, and reduced bleeding at the procedure site.

BLT 20 / 10 / 10

Benzocaine20%

Lidocaine10%

Tetracaine10%

Phenylephrine0.5%

Onset~15 min

Duration2–4 hr

FormCream or ointment

See MediCaine Pro

BLT+ QUAD-AGENT

Benzocaine20%

Lidocaine10%

Tetracaine10%

Prilocaine8%

Phenylephrine0.5%

Onset~15 min

Duration3–5 hr

See MediCaine Ultra

PHARMACOLOGY

HOW BLT CREAM ACTUALLY WORKS

Three local anesthetics, three different speeds, three different depths — engineered to overlap.

BENZOCAINE

Ester-class anesthetic. Penetrates the outer epidermal layer fastest. Responsible for the early "tingling" sensation patients describe within 5 to 10 minutes of application. Provides surface-level pain blockade.

FAST · SURFACE

LIDOCAINE

Amide-class anesthetic. The most widely used local anesthetic in clinical medicine, with decades of safety and efficacy data. Penetrates deeper than Benzocaine into the papillary and reticular dermis. Provides the bulk of clinical anesthesia.

CORE · DERMAL

TETRACAINE

Ester-class anesthetic. The most potent and longest-lasting of the three. Slow to onset but penetrates deepest and maintains anesthesia after the cream is removed. Responsible for the 2 to 4 hour duration tail.

DEEP · LONG

→ Full Pharmacology on the Science Page

CLINICAL USE

PROCEDURES THAT USE BLT CREAM

DERMATOLOGY

Skin biopsies, cryotherapy, laser resurfacing, Mohs surgery, mole removal, electrosurgery, ablative laser, fractional laser.

DENTISTRY

Pre-injection numbing, scaling and root planing, crown preparation, mucogingival surgery, periodontal procedures.

AESTHETIC MEDICINE

Dermal fillers, Botox, lip augmentation, microneedling, RF microneedling, chemical peels, PDO threads.

LASER TREATMENTS

Laser hair removal, laser tattoo removal, IPL photofacial, fractional laser, vascular laser, picosecond laser.

MICRONEEDLING

Traditional microneedling, RF microneedling (Morpheus8, Vivace, Genius), exosome therapy, PRP/PRF combination treatments.

LIP & FACIAL FILLERS

Lip augmentation, cheek and jawline filler, under-eye treatment, nasolabial fold correction, chin contouring.

APPLICATION PROTOCOL

HOW TO APPLY BLT CREAM

1

CLEAN AND DRY THE TREATMENT AREA

Wash the skin with mild soap and water. Pat completely dry. Do not apply BLT to broken, inflamed, or recently waxed skin without provider judgment.
2

APPLY A GENEROUS EVEN LAYER

Apply approximately 1 to 2 grams per 10 by 10 cm of skin. Rub in gently — do not occlude unless specifically called for by the procedure. Maximum single-use dose: 30 g of 20/10/10 BLT on intact skin without occlusion.
3

WAIT 15 TO 25 MINUTES

15 minutes for superficial procedures (Botox, IV access, light biopsies). 20 to 25 minutes for deeper procedures (fillers, microneedling, laser). Add 5 to 10 minutes if not using occlusion for deep procedures.
4

REMOVE COMPLETELY BEFORE PROCEDURE

Wipe the area thoroughly with gauze, then cleanse with alcohol or saline. This is especially critical before microneedling, laser, and any procedure that breaches the skin barrier — residual anesthetic can otherwise be driven into the dermis and increase systemic absorption.
5

PROCEED WITH PROCEDURE

Clinical anesthesia is at peak 30 to 45 minutes after application and persists 2 to 4 hours for standard BLT, 3 to 5 hours for quad-agent BLT+. For procedures longer than 2 hours, plan accordingly.

→ Full application guide

SAFETY

BLT SAFETY GUIDANCE

BLT cream is a high-concentration compound restricted to licensed providers because it requires clinical judgment.

MAXIMUM SAFE DOSE

For a healthy adult, approximately 30 g of 20/10/10 BLT on intact skin without occlusion. Larger body-surface treatments — such as full back or thigh laser hair removal — require divided dosing or step-down to a single-agent formulation. Pediatric, elderly, hepatic-impaired, and cardiac patients require provider judgment and lower dosing.

DO NOT APPLY TO

Broken or inflamed skin, mucous membranes (unless specifically indicated), eyes, large body surface areas under occlusion. Avoid in patients with known allergies to ester-class anesthetics (Benzocaine, Tetracaine) or amide-class anesthetics (Lidocaine). Caution in patients with methemoglobinemia risk.

OCCLUSION INCREASES ABSORPTION

Plastic film occlusion approximately doubles the rate of transdermal absorption. Use occlusion intentionally — for deep procedures requiring rapid onset — and reduce total dose accordingly. Never occlude broken skin. Always document occlusion in the procedure note.

REMOVE BEFORE BREACHING SKIN

Always remove BLT completely before microneedling, laser, biopsy, or any procedure that breaches the epidermis. Residual anesthetic driven into the dermis bypasses the normal absorption barrier and can produce systemic levels disproportionate to the topical dose.

COMPARE

BLT VS EMLA, LMX, AND OTC

FORMULATION	ACTIVES	TOTAL	ONSET	DURATION	ACCESS
MediCaine Pro (BLT 20/10/10)	Benz / Lid / Tet / Phen	40.5%	15 min	2–4 hr	Licensed providers
MediCaine Ultra (BLT+ quad)	Benz / Lid / Tet / Pri / Phen	48.5%	15 min	3–5 hr	Licensed providers
EMLA	Lid 2.5% / Pri 2.5%	5%	30–60 min	1–2 hr	Rx (some OTC)
LMX 4 / LMX 5	Lidocaine only	4–5%	30–45 min	1–2 hr	OTC
OTC Lidocaine	Lidocaine only	≤ 4%	30–45 min	1–2 hr	OTC

FAQ

BLT CREAM QUESTIONS

What is BLT cream?+

BLT cream is a compounded topical anesthetic that combines three local anesthetic agents — Benzocaine, Lidocaine, and Tetracaine — into a single multi-agent formulation. The standard concentration is Benzocaine 20%, Lidocaine 10%, and Tetracaine 10% (written 20/10/10), often with a small percentage of Phenylephrine as a vasoconstrictor. BLT is compounded by licensed 503A pharmacies and dispensed exclusively to licensed healthcare providers. It is used as a pre-procedure numbing cream for dermatology, dentistry, aesthetic injections, microneedling, laser treatments, and other minor procedures.

How long does BLT cream last?+

Standard BLT 20/10/10 provides clinical anesthesia for approximately 2 to 4 hours after onset, with peak effect at 30 to 45 minutes. With Phenylephrine added, duration runs toward the upper end of that range because the vasoconstriction slows systemic absorption. Quad-agent BLT+ formulations adding Prilocaine extend duration to 4 to 5 hours.

How long before treatment should BLT cream be applied?+

Apply BLT 15 to 25 minutes before the procedure. 15 minutes for superficial procedures (Botox, IV access). 20 to 25 minutes for deeper procedures (fillers, microneedling, laser). Use occlusion for faster onset on deep procedures, add 5 to 10 minutes if not using occlusion.

How much BLT cream should be used?+

Use 1 to 2 grams of BLT per 10 by 10 cm of skin. Maximum safe single-use dose for a healthy adult is approximately 30 grams of standard 20/10/10 BLT applied to intact skin without occlusion. Never exceed the maximum dose, never apply to broken or inflamed skin without provider judgment, and always remove residual cream before the procedure begins.

What procedures use BLT cream?+

BLT is used across multiple specialties: dermatology (biopsies, cryotherapy, laser resurfacing, Mohs surgery), dentistry (pre-injection numbing, scaling, crown prep), aesthetic medicine (fillers, Botox, lip augmentation, microneedling), laser treatments (laser hair removal, tattoo removal, IPL, fractional), and minor surgical procedures.

Is BLT cream FDA approved?+

The individual actives in BLT — Benzocaine, Lidocaine, and Tetracaine — are FDA-approved local anesthetics. The combined BLT cream is a compounded preparation prepared by a licensed 503A pharmacy under USP 795 standards on a per-prescription basis. Compounded medications are regulated by state boards of pharmacy and FDA compounding rules rather than approved as finished products. MediCaine compounds BLT in a USP 795 compliant facility and ships exclusively to NPI-verified licensed providers.

What is the difference between BLT and EMLA?+

EMLA is Lidocaine 2.5% + Prilocaine 2.5% — total concentration approximately 5%. BLT is Benzocaine 20% + Lidocaine 10% + Tetracaine 10% — total concentration approximately 40%, eight times the active load. BLT has a faster onset (15 minutes vs 30 to 60 minutes), greater depth, and longer duration. EMLA is available over the counter in some jurisdictions; BLT is restricted to licensed providers because of its concentration.

Can BLT cream be used before microneedling?+

Yes — it is the most common pre-procedure topical for microneedling and RF microneedling. Apply 20 to 30 minutes before, remove completely and clean the skin before treatment begins. See our microneedling numbing cream guide for detailed protocols.

Can BLT cream be used before tattoo or PMU procedures?+

MediCaine is sold exclusively to licensed providers. Licensed providers performing tattoo removal, paramedical tattooing, areola repigmentation, or permanent makeup procedures under medical supervision commonly use BLT as a pre-procedure topical. Always follow your state board's rules on topical anesthetic use in tattoo settings. See our tattoo numbing cream guide.

ORDER BLT CREAM

Compounded fresh per order in a USP 795 compliant facility. NPI verification required at checkout. Auto-reorder available.

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