From the Guidelines
I strongly recommend proceeding with the third cryotherapy treatment for viral warts on this 55-year-old male prison patient's left hand, as it is a well-established and effective treatment method for viral warts, with the most recent guidelines supporting its use 1. The treatment should be administered by applying liquid nitrogen directly to each wart for approximately 10-15 seconds per application, with a double freeze-thaw technique (apply, allow to thaw, then reapply) for optimal results. The treatment area should be allowed to thaw completely between applications. Post-procedure, the area should be kept clean and dry, and the patient should be advised that blistering, mild pain, and redness are normal responses. Acetaminophen can be offered for discomfort. A follow-up appointment should be scheduled in 2-3 weeks to assess treatment response and determine if additional sessions are needed, as multiple treatments are often required for complete wart resolution. Some key points to consider when performing cryotherapy include:
- The importance of proper training for healthcare providers to ensure safe and effective treatment 1
- The potential for local irritation, pain, or other side effects, which can be managed with topical or injected local anesthesia if necessary 1
- The need for repeated treatments, as success rates improve with multiple sessions 1 Cryotherapy works by creating intracellular ice crystals that damage cell membranes and induce tissue necrosis, effectively destroying the wart tissue and potentially triggering an immune response against the human papillomavirus causing the warts. Success rates improve with repeated treatments, and this being his third session suggests appropriate ongoing management of his condition. It is also important to note that other treatment options are available, including podophyllin resin, trichloroacetic acid (TCA) or bichloroacetic acid (BCA), and surgical removal, but cryotherapy is a recommended and effective treatment method 1.
From the Research
Treatment of Viral Warts with Cryotherapy
- Cryotherapy is an effective and widely used method for treating common warts, with patients often requiring multiple sessions at variable intervals 2, 3.
- The procedure involves applying liquid nitrogen to the affected areas, and the patient's response is closely monitored 2.
- A study comparing two cryotherapy protocols found that a single cycle of 10 seconds of freezing at 2-weekly intervals resulted in a higher cure rate (77.8%) compared to a single cycle of 20 seconds of freezing at 4-weekly intervals (54.3%) 2.
- Another study found that cryotherapy was the most effective therapy for common warts, with a cure rate of 49% compared to 15% for salicylic acid and 8% for a wait-and-see approach 3.
Comparison of Cryotherapy Methods
- A study comparing the use of a cryo-spray and a cotton wool bud for applying liquid nitrogen found that both methods were equally effective, with cure rates of 47% and 44%, respectively 4.
- The choice of method may depend on the specific clinical situation and patient factors, such as the size and location of the warts 4.
Safety and Efficacy of Cryotherapy
- Cryotherapy is generally considered safe and effective for treating common warts, with few adverse effects reported 2, 5.
- Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain, although these are typically mild and temporary 5.
- Cryotherapy may be less effective for plantar warts, with one study finding no significant difference in cure rates between cryotherapy and other treatments 3.