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John L. Pfenninger, M.D.
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Cryotherapy of Skin Lesions
Preoperative Patient Education
Cryotherapy means treatment with extreme cold. The area that is treated actually freezes and then falls off. There are several different ways that the treatments can be carried out.
Liquid nitrogen is -196°C. It can either be poured out into a Styrofoam cup and applied with a cotton-tipped applicator, or, sprayed onto the growth with a special thermos-like gun.
Another method is to use nitrous oxide in a blue tank. This gas is -89°C and has a similar effect. It is less cold so it may take a little longer to achieve the proper effect. A special unit with different types of points is used to freeze the tissue.
A third method is to use refrigerants that are compressed gas in a small can. These are around a -40-50°C and the area to be treated is sprayed with this gas.
Cryotherapy offers several advantages. It is very effective. Both benign and malignant (cancer) changes can be treated. One of the advantages of using cryotherapy is that the final result is generally cosmetically excellent. There is minimal or no scarring. It is very quick and if there are only a few lesions, relatively painless. If there are large lesions or numerous lesions, the doctor may want to numb up the area first. Infection is extremely rare and there is no bleeding. Postoperative care is minimal except for washing the area three to four times a day with soap and water and applying antibiotic ointment. Generally, patients can bathe and go about their usual daily activities.
There are some disadvantages. The freezing does have some discomfort associated with it as does the thawing. That is why we will numb up the area if there are large lesions or multiple lesions present. Many times the treated area will not completely resolve and will need a second treatment. It is difficult to treat areas where there is hair growth such as around the eyebrows and eyelashes since hair may not grow back in the treated areas. Probably the most significant “hassle factor” is that a blister will often form just as if you burned yourself. When this blister breaks, there is often a very heavy watery discharge. If the area treated is under clothing, this area may stick to the clothes and cause discomfort. Apply antibiotic ointment and keep it covered to prevent this. If you are a light-skinned individual, cryotherapy is ideal for you. However, if you are dark-skinned, the area treated may heal with a lighter color. This may not be of concern if the area is usually covered, but if it is going to be around the face or some other cosmetic area, then it may be best not to do cryotherapy.
Preparation for the office visit. No real preparation is necessary for the office visit. You may want to take Tylenol or 600-800 mg of ibuprofen just to help decrease the swelling afterwards. Let the doctor know if you would prefer to have an injection to numb up the area.
Who should not have cryotherapy? If you have any type of arthritis condition, ulcerative colitis, glomerulonephritis, heart valve infection, syphilis, mono, cytomegalovirus infection, hepatitis, diabetes, peripheral vascular disease, Burger’s disease, are on steroids, or are known to have high levels of cryoglobulins, be sure that your doctor knows. You may be much more sensitive to the freezing.
As stated above, if you are dark-skinned, you may want to choose another method of treatment due to possible loss of color in the area treated.
When should I see results? If any treated spot has not totally gone away in six weeks, see the doctor for a recheck appointment.
Copyright, 2011. John L. Pfenninger, M.D. Cryo preop jw11/10