Peter Lio, MD: Minimizing Discomfort in Dermatologic Procedures

Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University, recently presented at the 2025 American Academy of Dermatology (AAD) Annual Meeting. His talks included "Pain-Free Dermatology: Minimizing Discomfort in Procedures for Children and Adults," "Dietary Triggers and Modifications of Common Dermatologic Conditions: An Evidence-Based Approach," and "Skin and Systemic Malignancy."

Lio spoke with Dermatology Times to share key takeaways from his discussion on reducing procedural pain in dermatology.

Peter Lio, MD

The Importance of a Pain-Free Approach

Lio’s session on pain-free dermatology stemmed from his early experiences in pediatric care.

"When I did my internship, I did my internship in pediatrics at Boston Children's and Boston University, and we had a fantastic program concept where the goal was to do pain-free pediatrics, to do everything you could to make sure the kids undergoing procedures had minimal discomfort," he said. This foundational experience inspired him to develop a similar approach in dermatology, where procedural pain management is often overlooked.

"In dermatology, we don’t think so much about the patient’s discomfort," Lio explained. "We’ll quickly do a curette for a kid, sometimes without any topical numbing, sometimes even just the initial lidocaine that we’re going to give before a procedure, we’ll do it quickly. It’s sort of cold, and maybe it came right out of the refrigerator. It’s really unpleasant, and we’re not really thinking about all these little issues."

Practical Strategies for Minimizing Pain

Lio outlined several strategies to create a more comfortable experience for patients undergoing dermatologic procedures. One fundamental component is effective communication and setting up a relaxed environment.

"One of the key things, I think, is really communicating with the patient and setting up a comfortable environment where everybody feels relaxed and they sort of know what’s about to happen," he emphasized.

Another essential method involves the use of topical anesthetics. While some clinicians may dismiss them as ineffective or inconvenient, Lio believes they offer incremental benefits.

"When we can use them, they’re kind of a pain in the neck. They don’t do that much. It’s almost... the juice is not worth the squeeze. But I do think for many patients, it can be—it’s just one more little level," he said. "Be it one of the patches—there are some really nice patches now that you can put on the skin that make it very easy—or if you’re just using a little bit of cream or ointment, lidocaine or tetracaine or prilocaine or mixtures thereof, putting them on there and then putting a little bit of an occlusive over it, that can help even just a little bit."

Cooling and Vibration Techniques

Cooling the skin prior to a procedure can also help reduce discomfort.

"Putting an ice pack down can be really helpful for any kind of a procedure that’s about to happen," Lio noted.

Pairing cooling with vibration therapy enhances its efficacy.

"There are little devices. One of the ones I like is shaped like a little bumblebee, and you place it on the skin, it kind of buzzes, and that distracts the patient," he explained. "We’re not only distracting them psychologically because they have this buzzing thing, but we’re also affecting the nerve system, which is really neat. Very directly, we also talk about some of the different things that are maybe unconventional, including things like aromatherapy."

The Psychological Component: Distraction and Comfort

Psychological strategies play a significant role in pain management. Distraction techniques, such as giving children toys or utilizing digital devices, can shift the patient’s focus away from discomfort.

"For adults and kids alike, we can use things like our smartphones or iPad-type devices. They can play a game, and they can get so immersed in it that that piece of their consciousness is far away, and that can help as well," he said.

By integrating these techniques, dermatologists can significantly improve patient experiences.

"When we do a procedure that’s less painful, less uncomfortable for the family and the patient, everybody wins," Lio emphasized. "The procedure actually has a higher rate of going more smoothly. The patient’s more comfortable directly, and if there’s family or parents around, it’s so much easier for them too. Instead of having to hold a screaming child or an adult who’s really upset and anxious, everybody has such a nicer experience with it, and that really, I think, helps us in the long term as well."

Conclusion

While implementing pain-minimization strategies requires extra effort, Lio believes the long-term benefits far outweigh the costs.

"Even though it is a bit more work, I do think it’s one of those things where the costs are far outweighed by those benefits, both tangible and intangible over time, where patients come back and say, 'Hey, I’m ready to do something else. The last time wasn’t so bad at all.'”