Is cryotherapy suitable after minor bleeding from wart debridement?

From the Guidelines

It is generally not recommended to proceed with cryotherapy if there is bleeding after paring a wart. Minor bleeding indicates that the paring has reached the dermal layer, which can increase the risk of scarring and pain during cryotherapy. The presence of blood can also interfere with the effectiveness of the cryotherapy treatment by creating a barrier between the freezing agent and the wart tissue. Instead, hemostasis should be achieved first, typically by applying pressure with sterile gauze or using a chemical hemostatic agent like aluminum chloride or silver nitrate. Once bleeding has completely stopped, it's best to reschedule the cryotherapy for another day to allow the area to heal. This approach minimizes the risk of complications such as excessive pain, blistering, infection, and scarring. The healing period also helps ensure that subsequent cryotherapy will be more effective and better tolerated by the patient, as supported by the guidelines for the management of cutaneous warts 1. Some key points to consider when treating warts include:

• The use of cryotherapy with liquid nitrogen or cryoprobe, which can be repeated every 1-2 weeks 1
• The application of trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80%-90% to warts, which can be repeated weekly if necessary 1
• Surgical removal of the wart, which can be considered in some cases 1 However, the most recent and highest quality study, the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1, does not specifically address the issue of bleeding after paring a wart, but it does provide guidance on the use of cryotherapy and other treatments for warts. Therefore, the decision to proceed with cryotherapy after bleeding has stopped should be made on a case-by-case basis, taking into account the individual patient's situation and the potential risks and benefits of the treatment. In general, it is best to err on the side of caution and prioritize the patient's safety and well-being, as supported by the principles of evidence-based medicine and the guidelines for the management of cutaneous warts 1.

From the Research

Cryotherapy for Warts

• The provided studies do not directly address the question of whether it is okay to proceed with cryotherapy if there is minor bleeding after paring a wart 2, 3, 4, 5, 6.
• However, cryotherapy is a common treatment for cutaneous warts, and its efficacy has been compared to other treatments such as salicylic acid and cantharidin-podophylotoxin-salicylic acid in various studies 2, 3, 4, 5.
• The safety and efficacy of cryotherapy have been evaluated in several studies, with some showing higher cure rates compared to other treatments 4, 6.
• Minor bleeding after paring a wart may not be a contraindication for cryotherapy, but it is essential to consider the individual patient's condition and the potential risks and benefits of the treatment.
• The decision to proceed with cryotherapy should be made on a case-by-case basis, taking into account the patient's overall health, the severity of the wart, and the potential for complications 2, 3, 4, 5, 6.

Considerations for Cryotherapy

• Cryotherapy can be an effective treatment for common viral warts, with cure rates ranging from 39% to 77.8% in different studies 4, 6.
• The treatment protocol, including the freezing time, number of cycles, and intervals between sessions, can vary and may impact the efficacy and safety of the treatment 6.
• Potential complications of cryotherapy include pain, blistering, dyspigmentation, and scarring, but these can be minimized with proper technique and patient selection 4, 5, 6.
• The recurrence rate of warts after cryotherapy can be significant, ranging from 17% in one study 6.
• Further research is needed to determine the optimal treatment protocol for cryotherapy and to compare its efficacy and safety to other treatments for cutaneous warts 2, 3, 4, 5, 6.