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Cryotherapy & Verrucas

‘Cryotherapy’ literally means ‘treatment using low temperature’ and refers to the process of treating of skin lesions by freezing them with liquid nitrogen. It is used to help treat benign skin lesions including warts, skin tags and sometimes other conditions as small areas of actinic keratosis and seborrhoeic keratosis.

Cryotherapy is not mandated to be offered on the NHS by their GP. It is an optional service we offer our patients.

Until now patients were booking for cryotherapy in routine and urgent/same day appointments with a doctor, often in peak and significantly reducing the pool of available appointments. This meant that patients with urgent problems were unable to access a doctor as the appointment was being used for treatment which is optional and non-urgent.

Cryotherapy requires special equipment which needs to be prepared and may not be available in a random appointment and when offered, is more suitable for a dedicated clinic. For these reasons we can only offer cryotherapy in dedicated cryotherapy clinics.

There is clear national guidance and evidence on when to use cryotherapy, in particular for common conditions like verrucas and we have drafted a policy based on this and outlined below:

Cryotherapy is not harmless treatment. The liquid nitrogen is -196C and used to cause freezing damage, like a burn. Therefore this treatment has similar risks to burns which includes :

·        - transient pain and redness

·         -swelling

·         -infection

·         -dependent on the individual it can cause significant scarring including keloid scarring – especially in those with a tendency to scar

·         -pigmentation changes including both dark and light patches – more noticeable in the darker skin

·        - nerve damage that may manifest as prolonged numbness or pain

For the above reasons, cryotherapy is not appropriate for everyone and does depend on where the lesion is. We tend to avoid doing cryotherapy in children and on the face.

Please be aware by verbally agreeing to have cryotherapy, you will be consenting to have a procedure and in doing so  you will also be accepting the risks associated with the procedure – as outlined in the previous paragraph.

If the doctor/physician associates deem it appropriate to you cryotherapy for your skin lesion, they book you into the next appropriate appointment in the dedicated cryotherapy clinic.  

Please refer to the following link/document for more information: http://www.bad.org.uk/shared/get-file.ashx?id=192&itemtype=document

 

Verrucae

Verrucae are warts and do not usually cause symptoms. Most warts will usually resolve spontaneously within months or, at the most, within 2 years. However sometimes in adults it may take 5-10 years for warts to resolve. Remember they are caused by a virus which can spread to other areas of the same patient and to other individuals.

It is important to cover them, as not only does that reduce the spread but is also considered a form of treatment. It is best to avoid catching the virus by taking the usual precautions i.e. avoid any direct contact with the virus such as avoid touching verrucae’s and using slippers in public showers and next to pools.  

Following evidence based guidelines and national recommendations (as per the links below) and in order to maximise the chances of success, we will only offer cryotherapy to verrucaes if:

1.      The patient has tried to treat it themselves for a minimum of 3 months, which includes:

a.      Filing the lesion regularly to remove as much dead skin as possible i.e twice weekly with a pumice stone.

b.      And has been using topical salicylic acid daily

c.       As well as applied occlusive tape, which reduces oxygen, stops spreading, softens the skin and also holds in the acid.

2.      If the above has failed then we can offer up to four sessions of cryotherapy at minimum intervals of 4 weeks,  per year.  If treatment has not been successful after the 4 sessions it is unlikely to work and the risk of adverse effects and harm increases.

3.      During cryotherapy it is important that patients adhere with the 3 treatment recommendations outlined in point 1, otherwise the likelihood of cryotherapy being successful is very low. If the verrucae has lots of dead skin on top, the layers of dead skin will reduce the efficacy of the cryotherapy and salicylic acid from penetrating, not to mention increase the risk of harm to the surrounding healthy skin.

https://cks.nice.org.uk/warts-and-verrucae#!scenario

https://www.bmj.com/content/342/bmj.d3271

https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/warts-and-verrucas

http://www.bad.org.uk/shared/get-file.ashx?id=176&itemtype=document

 

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