DERMATOLOGY

What is Cryotherapy

It is an effective treatment method by creating cold damage to the tissue by using various cryogens (chemicals that provide freezing effect in the tissue) with appropriate equipment.

In dermatology practice, it is used to burn many benign formations such as warts, moles, seborrheic keratosis, pyogenic granuloma, and it is also frequently used in the treatment of some cancer and precancerous diseases such as actinic keratosis, basal cell carcinoma and Bowen's disease.

Among various cryogens such as ethyl chloride, solid carbon dioxide, freon, liquid nitrogen is the most suitable for dermatological application.

A) Before Application

1-The practice room should provide the conditions required for minor surgical interventions (equipment, cleaning, etc.).

2- In addition to the standard preoperative evaluation, the presence of disease that may prevent the application of cryotherapy should be questioned (cold urticaria, cold intolerance, cryoglobulinemia, cryofibrinogenemia, severe arteriosclerosis in the lower extremities, etc.).

3- Before starting the application, the patient should read and sign the informed consent, which includes detailed information about the complications that may occur during and after the application of cryotherapy. If the patient is under the age of 18, it must be signed by the legal guardian.

4- Registration and photographing of the patient should be done carefully.

5- Dermatopathological diagnosis should be provided before the application in premalignant and malignant lesions.

B) Application

1-The area to be frozen should be marked with a pencil.

2- Care should be taken that the ice ball completely covers the lesion area and moves 2-3 mm around it (benign lesions). A single freezing cycle is usually sufficient for benign and premalignant lesions. For malignant lesions, a double freezing cycle is usually applied.

3- It can be used in combination with other methods (curettage, electrosurgery, cutting with scissors, etc.) to reduce the swelling of the lesion (to increase effectiveness), to better assess the width and depth of the lesion, to obtain a piece of tissue for dermatopathological examination.

4- Considering that complications such as contracture and scarring may develop after cryotherapy applications, excessive applications should be avoided.

C) Postoperative Evaluation

1- It is sufficient to wash the application area 2-3 times a day with soap and water or to do a daily fire with povidone iodine solution. The crust formed will fall off by itself. If the crust on the wound is very adherent under it, then antibiotic ointment can be applied twice a day. Especially in malignancies, in case of excessive exudation at the beginning, a dry gauze dressing can be applied first, and then antibiotic ointment can be applied.

2- For the control, an appointment should be made 2-3 weeks later on average. At least two weeks should be waited for a second application.

Side Effects and Complications

Edema, throbbing pain, bleeding, headache, secondary infection, syncope, febrile reaction, nitrogen gas under the skin manifested by crepitation, milium, pyogenic granuloma, hypertrophic scar, hyperpigmentation, paresthesia, neuropathy, tendon rupture, alopecia, ectropion, hypopigmentation, defect formation in the tissue, cartilage necrosis, retraction and notching of the tissues.

Comment

Cryotherapy in skin tumors can be applied only for palliative purposes in tumors that can metastasize. In actinic keratosis, cryotherapy should be applied to all lesions for as long as necessary, keeping cosmetic concerns in the background. Patients should be ensured to come for regular check-ups.

Cryotherapy is an effective, practical, easy-to-apply, and economical method that generally does not require anesthesia, used in the treatment of benign, premalignant and malignant lesions. With these features, it has an important place in the daily life of the dermatologist.