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This supplement is published by the BDNG Dermatological Nursing, 2011, Vol 10, No 2 (suppl). Cryotherapy – Introduction. Cryotherapy: the destruction of skin lesions using a cold substance most commonly liquid nitrogen LN 2 (-196°C; -321°F) destruction is selective, affecting tissue only

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slide1

This supplement is published by the BDNG

Dermatological Nursing, 2011, Vol 10, No 2 (suppl)

cryotherapy introduction
Cryotherapy – Introduction

Cryotherapy:

  • the destruction of skin lesions
  • using a cold substance
  • most commonly liquid nitrogen LN2(-196°C; -321°F)
  • destruction is selective, affecting tissue only
  • induction of an effective immune recognition of viral or tumor cells
cryotherapy indications
Cryotherapy - Indications

Treatment of:

  • Benign lesions
  • Premalignant lesions
  • Malignant lesions
cryotherapy contraindications
Cryotherapy - Contraindications

There are no absolute

contraindications

Caution is needed

when treating the

following conditions:

cryotherapy equipment
Cryotherapy - Equipment

The equipment required

depends on the method

and technique used

Methods:

  • Open spray - 40̊C
  • Cotton bud - 20̊C
  • Metal forceps - 15̊C
cryotherapy methods
Cryotherapy - Methods

Spray:

Spot freeze most commonly

used for lesion up to 2cm

diameter

If lesion is over 2cm

diameter use paint brush

or rotary/spiral technique

Include rim of normal tissue

cryotherapy techniques
Cryotherapy - Techniques

Following the freezing the

lesion must thaw fully as this is

part of the cell destruction

  • Spray – 1cm distance from lesion
  • Freeze time starts from when the area is white
  • Once ice has developed continue for an appropriate time of 5-30 seconds intermittently

A freeze / thaw cycle is used

cryotherapy procedure2
Cryotherapy - Procedure
  • Only suitable for small,
  • superficial lesions
  • Useful when treating
  • young children
cryotherapy viral warts1
Cryotherapy – Viral Warts

Viral warts:

Infection of the epidermis

Human papilloma virus (HPV)

Treatment:

Either with spray or cotton

bud

A bud should be used on the

face

Two freeze thaw cycles are

recommended

cryotherapy skin tags
Cryotherapy – Skin Tags

Skin Tags:

Common, soft, harmless

lesion of collagen and blood

vessels

Treatment:

Forceps method or spray

method

For spray method hold tag

away from skin and freeze

through the base of tag

cryotherapy seborrhoeic warts
Cryotherapy – Seborrhoeic Warts

Seborrhoeic Warts:

Common benign lesions

often starting in adulthood

Warty, waxy, stuck on

appearance

cryotherapy molluscum contagiosum
Cryotherapy – Molluscum contagiosum

Molluscum contagiosum :

Small (1-5mm) lesions

caused by pox virus infection

of the skin

Common in :

Atopic eczema

Immunocompromised

patients

Children

Treatment:

Spray method

cryotherapy sebaceus hyperplasisa
Cryotherapy – Sebaceus Hyperplasisa

Sebaceous Hyperplasisa :

Enlarged sebaceous

glands

Common in :

Middle aged or elderly

patients

Immunocompromised

patients

Torré-Muir syndrome -

sebaceous gland tumor

Treatment:

Spray method

cryotherapy millia
Cryotherapy – Millia

Millia:

Tiny, superficial, keratin

filled epidermal cysts

Common in :

Infants and adults

Congenital or acquired

Can result from physical

trauma

Sebaceous or sweat duct

plugging

Treatment:

Spray method

cryotherapy actinic solar keratoses
Cryotherapy – Actinic/Solar Keratoses

Actinic kerartosis:

Hyperkeratotic lesion,

chronic sun damage

Pink, scaly, warty or

crusted lesion

Common in :

Adult skin

Light skinned individuals

Treatment:

Spray method

cryotherapy bowen s disease
Cryotherapy – Bowen’s disease

Bowen’s disease:

Persistent, non-elevated,

red, scaly or crusted plaque

Has small potential for

invasive malignancy to SSC

Can grow several cm in

diameter

Common in :

Elderly patients

Lower legs

Treatment:

Spray method

actinic cheilitis bcc
Actinic Cheilitis BCC

Actinic Cheilitis

Superficial BBC

cryotherapy side effects
Cryotherapy – Side effects
  • Pain
  • Oedema/Blister
  • Ulceration
  • Nerve/tendon damage
  • Pigment change
  • Scarring
  • Infection
  • Urticaria
cryotherapy safety
Cryotherapy - Safety

Precautions

Storage

Liquid nitrogen should always be

stored in a well ventilated room.

Personal protective equipment

When decanting liquid nitrogen non

absorbent insulated gloves and a full

face visor should be worn. Open

toed shoes should not be worn

Transportation

If liquid nitrogen is to be transported

in a vehicle, the driver must be

aware of potential hazards,

Especially asphyxiation, and know

what to do in the event of an

accident or emergency (BOC, 2004).

It should only be transported where

the load space is separated from the

driver and passenger compartment.

Liquid nitrogen containers should be

  • transported in a secure upright position
  • in a well-ventilated area (BOC, 2004).
cryotherapy safety1
Cryotherapy - Safety

COSHH regulations apply

Hazards include:

  • Asphyxiation in poorly ventilated areas
  • Chronic burns
  • Cryogenic burns / frost bite
  • Hyperthermia

Wear protective

equipment when handling

Emergency action:

Inhalation:

  • Remove individual from area
  • Do not place yourself at risk
  • Breathing apparatus may be used
  • Keep individual warm

Skin/Eye contact:

  • Immerse affected area in tepid 42-45°C for at least 15min and cover with dry, sterile dressing
cryotherapy also covers
Cryotherapy – also covers…
  • Medicolegal aspects
  • Appendix 1: Assess competency according to WASP framework
  • Appendix 2: Methods for removal of keratin
  • Appendix 3: Check list for cryotherapy
slide30

Dermatological Nursing, 2011, Vol 10, No 2 (suppl)

BDNG

Tel: 020 7681 6131

www.bdng.org.uk