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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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This supplement is published by the BDNG

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

cryotherapy introduction
Cryotherapy – Introduction


  • 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


Caution is needed

when treating the

following conditions:

cryotherapy equipment
Cryotherapy - Equipment

The equipment required

depends on the method

and technique used


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


Spot freeze most commonly

used for lesion up to 2cm


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)


Either with spray or cotton


A bud should be used on the


Two freeze thaw cycles are


cryotherapy skin tags
Cryotherapy – Skin Tags

Skin Tags:

Common, soft, harmless

lesion of collagen and blood



Forceps method or spray


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


cryotherapy molluscum contagiosum
Cryotherapy – Molluscum contagiosum

Molluscum contagiosum :

Small (1-5mm) lesions

caused by pox virus infection

of the skin

Common in :

Atopic eczema





Spray method

cryotherapy sebaceus hyperplasisa
Cryotherapy – Sebaceus Hyperplasisa

Sebaceous Hyperplasisa :

Enlarged sebaceous


Common in :

Middle aged or elderly




Torré-Muir syndrome -

sebaceous gland tumor


Spray method

cryotherapy millia
Cryotherapy – Millia


Tiny, superficial, keratin

filled epidermal cysts

Common in :

Infants and adults

Congenital or acquired

Can result from physical


Sebaceous or sweat duct



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


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


Common in :

Elderly patients

Lower legs


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



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


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:


  • 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

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


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