Cryotherapy, also commonly known as cryosurgery, is one of several treatment methods for keratosis – along with curettage, laser, electrocautery or even a surgical procedure. According to reliable research, cryotherapy follows surgical procedures in the ranking of treatments most frequently performed to remove skin lesions due to its availability in the doctor’s office.
To get rid of undesirable types of skin lesions such as warts, actinic and seborrheic keratosis, cryotherapy uses extreme cold to freeze the lesions, which then dry and flake off from the skin. This treatment works only for flat or slightly-elevated lesions.
So how does cryotherapy work? Cryotherapy constricts the blood vessels at the site of the injury or in the case of keratoses, at the lesions’ site. This vasoconstriction (the medical term for constriction of the blood vessels) reduces the blood flow into the site. Oxygen supply, along with other vital nutrients required for a cell’s survival, decreases due to insufficient blood supply. Eventually, the resulting effect is cell death or necrosis.
Liquid nitrogen, carbon dioxide snow and DMEP or dimethyl ether and propane, are some of the substances used to generate extremely cold temperatures which are known as cryogens. Due to its efficiency in removing skin lesions, mainly because of its low boiling point, most doctors prefer to use liquid nitrogen when performing cryotherapy.
Using a tool that would prevent the doctor’s direct contact with liquid nitrogen such as a cotton bud, a spraygun or a probe, the doctor starts the process by directly applying the liquid nitrogen onto the patient’s skin. Then, the heat from the skin instantly transfers to the liquid nitrogen making it evaporate quickly, usually within a minute or so. After this brief period of freezing comes the thawing of the lesions. This is the time that the actual cell injury starts to occur – when the intracellular contents begin to leak out. Lastly, cell inflammation, characterized by skin redness, edema or swelling, pain and warmth, occurs as the cells’ final response to cell death.
No one should be afraid to have cryotherapy since it is a generally safe procedure as long as treatment protocols are followed strictly. But complications are always a part of any procedure, be them low-risk or high-risk. To illustrate, prolonged freezing by the liquid nitrogen can result in hypopigmentation or loss of pigment in the treated area.
Even though the Resource Conservation and Recovery Act does not consider liquid nitrogen hazardous, it still poses as a danger to humans who come in direct contact with it for this will result in rapid freezing of the tissues or even tissue death. Exposure to liquid nitrogen can be through inhalation or direct contact. Inhalation effects are not that toxic unless a significant amount of liquid nitrogen is spilled, thereby reducing oxygen levels prompting the need for respirators. Extreme care must therefore be observed during its transportation.
When transferring liquid nitrogen into smaller containers, it can splash into the direction of the eyes causing injury such as a cryogenic burn. The skin can also be accidentally subjected to the dangers of liquid nitrogen.
Therefore, for both the medical practitioners and the laypersons alike: practice utmost safety when handling liquid nitrogen. Goggles, face shields, masks, gloves, aprons and other encapsulating suits should always be your first line of defense from liquid nitrogen. In cases of leaks, any person not wearing any protective gear must leave the area until cleaning is completed. And if liquid nitrogen ever comes in contact with the skin, and not during a planned cryotherapy procedure, the frozen skin should be soaked in water that is 41-46 degrees Celsius in temperature before immediately consulting a doctor.
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