What is the policy for administering cryotherapy (cryosurgery) in a medical practice?

From the Guidelines

Cryotherapy should be delivered using liquid nitrogen, with proper patient selection, informed consent, and equipment preparation to minimize morbidity and mortality, and improve quality of life. When considering treatment options, cryotherapy with liquid nitrogen is a recommended approach, as outlined in the guidelines for treating sexually transmitted diseases 1. The treatment protocol involves applying a small amount of liquid nitrogen to the affected area, typically for 5-30 seconds, depending on the condition and location. For warts, the treatment should continue until a 1-2mm white halo appears around the lesion, while for actinic keratoses, a shorter freeze time of 5-10 seconds is usually sufficient.

Some key considerations for delivering cryotherapy include:

• Proper patient selection, including those with warts, actinic keratoses, seborrheic keratoses, and certain skin cancers
• Obtaining written informed consent, explaining potential side effects such as pain, blistering, scarring, and hypopigmentation
• Equipment preparation, including a cryotherapy unit with liquid nitrogen (-196°C), appropriate applicators, and protective gear for staff
• Post-procedure care, including instructing patients about normal healing, wound care, and when to seek medical attention

It is also important to note that alternative treatment options, such as TCA or BCA 80%-90% applied to warts, or surgical removal, may be considered in certain cases 1. However, liquid nitrogen cryotherapy remains the preferred treatment option due to its effectiveness and relatively low risk of complications. By following proper treatment protocols and taking necessary precautions, cryotherapy can be a safe and effective treatment for various dermatological conditions, ultimately improving patient outcomes and quality of life.

From the Research

Medical Practice Policy for Delivering Cryotherapy

Introduction to Cryotherapy

Cryotherapy is a medical treatment that uses low temperatures to destroy abnormal or damaged cells, and it has been widely used for various medical conditions, including cutaneous warts, actinic keratoses, and chronic pain 2, 3, 4.

Indications for Cryotherapy

Cryotherapy can be used for the treatment of:

• Cutaneous warts, with a cure rate of 39% after 13 weeks 2
• Actinic keratoses, with a clearance rate of 97.4% after 3 months 3
• Chronic pain, with local and non-local cryotherapy applications showing promise in reducing pain associated with various chronic diseases 4
• Musculoskeletal disorders, with moderate certainty of evidence for reducing pain and improving range of motion after surgical procedures 5

Contraindications for Cryotherapy

Cryotherapy may not be suitable for all patients, and contraindications include:

• Certain medical conditions, such as Raynaud's disease or poor circulation
• Pregnancy or breastfeeding
• Certain medications, such as blood thinners

Administration of Cryotherapy

Cryotherapy can be administered using various methods, including:

• Liquid nitrogen cryotherapy, which is commonly used for cutaneous warts and actinic keratoses 2, 3
• Ice packs or cold compresses, which can be used for local cryotherapy
• Whole-body cryotherapy or partial-body cryotherapy, which can be used for non-local cryotherapy

Safety Precautions

To ensure safe administration of cryotherapy, the following precautions should be taken:

• Use protective equipment, such as gloves and goggles, when handling liquid nitrogen
• Monitor patient temperature and vital signs during treatment
• Avoid overcooling or prolonged exposure to cold temperatures
• Follow proper sanitation and hygiene procedures to prevent infection

Patient Education

Patients should be educated on the following:

• The purpose and benefits of cryotherapy
• The potential risks and side effects, such as pain, erythema, or edema
• The importance of following post-treatment instructions, such as avoiding strenuous activity or exposure to cold temperatures
• The need for follow-up appointments to monitor treatment efficacy and potential side effects

Treatment Outcomes

Treatment outcomes should be monitored and recorded, including:

• Efficacy of treatment, such as clearance rate or reduction in pain
• Adverse effects, such as pain, erythema, or edema
• Patient satisfaction and quality of life
• Need for additional treatments or follow-up appointments

Future Research

Future research is needed to evaluate the optimal timing, temperature, dose, and frequency of cryotherapy for various medical conditions, as well as to standardize treatment protocols and outcomes measurement 5.