Wouldn’t it be nice to improve the quality of skin lesion treatment ?

1. Wouldn’t it be nice to improve the quality of skin lesion treatment ?

2. Agenda • Wart and Skin Lesion Treatment Modalities • What is Cryotherapy? • Traditional application of Cryotherapy • The innovation of CryoPen. • How to apply.

3. Warts Warts are most common on the hands, feet or genitals. They are caused by HPV-infections and are commonly known as Verrucae Vulgaris.

4. Why should warts be treated quickly ? When small, a wart is more easily removed. When removed, a wart will no longer be the origin of further spread. Prevention and service to patients…

5. Cosmetic lesions Removing cosmetic skin lesions is becoming increasingly common as we all aspire to be attractive and stay youthful as we age. Wouldn’t it be nice to improve your treatment modality for these lesions.

6. Family Physicians in General Practice • My Patients have no Warts. • I don’t treat Warts or Skin Lesions. • I treat Warts with a variety of alternatives to Cryotherapy because of no Liquid Nitrogen available. • I send my Patients to the Pharmacy. • I send my Patients to the Dermatologist.

7. How do Dermatologists perform Wart/Skin Lesion Treatment ? Dermatologists usually treat Warts and Skin Lesions by freezing this tissue. Cryotherapy is called the golden standard for Skin Lesion Treatment in Medical Practice.

8. What are the alternatives ? HF-surgery and laser Disadvantages; • Pain – Anaesthesia required • Risk of collateral damage. • Risk of depigmentation, mainly in darker skin • Scars easily.

9. Why Cryotherapy ? Literature confirms that Cryotherapy is the practical, fast and primary form of treatment for Warts. Preparation and follow-up care are minimal to non-existent. If correctly applied, it is well tolerated by children and adults.

10. Definition of cryotherapy “Cryotherapy is the controlled destruction of unwanted tissue by the precise application of extreme cold.”

11. Plantar Wart

12. First freeze 30 sec, same session second freeze 30 sec Immediately after Treatment

13. Aseptic Necrosis of the treated tissue shows within 3 days.

14. 7 to 10 days after the Treatment the scab will disintegrate.

15. Healing is complete after 3 to 6 weeks.

16. Wart on hand

17. Necrosis of the tissue within 7 Days.

18. The crust has disintegrated and the tissue will fully regenerate within the next few weeks.

19. Healing is complete after 3 to 6 weeks.

20. The advantages of Cryotherapy • Sterile procedure: No excision, no risk of infection. • No pain treatment: no need for local anaesthetic. • Fast procedure: Follow-up care not necessary. • Safe: no damage from overenthusiastic use. • Speed of operation. • Excellent results.

21. Are these claims confirmed in daily practice? • No blisters, no pain? • Always good results? • Will one or two treatments cure the lesion? • Definitive result?

22. Cryotherapy The success/result of Cryotherapy Treatment will depend on the level of the user’s expertise. What are the criteria for successful Treatment?

23. Cell structure Cell membrane Nucleus Intracellular fluid Extracellular fluid

24. Osmose: Principle of Cell Preservation At slow freezing rates cells are given time for self protection. Slow freeze Fast thaw Cell Membrane Nucleus Intracellular fluid Extracellular fluid

25. Principle of Cell Destruction Intracellular fluid freezes, tiny spiked shards of ice are formed, cell membranes rupture, which will be the cause of Cell Destruction. Fast freeze Slow thaw Cell Membrane Nucleus Intracellular fluid Extracellular fluid

26. Effective cryonecrosis from -27°C It is described extensively in literature that: “rapid freezing to minus (-) 27°C and more will produce cryonecrosis in all human tissues”.

27. Why second freeze after 30 seconds? When freezing is too slow, extracellular ice formation occurs, which has the effect of insulating cells and preserving them rather than the desired opposite.

28. Rapid freeze, slow unassisted thaw Fast lowering of the temperature from +37°C to -27°C TWO freezing cycles in ONE treatment session Enough freezing power should be available to reach the bottom of the wart. Key criteria of cryonecrosis

29. Traditional Cryotherapy treatment Application with a cotton bud soaked with Liquid Nitrogen

30. A hassle to store and to refill

31. No control of energy transmission Cotton buds will rapidly lose energy

32. No control over temperature No control over energy = No control over temperature

33. No Control Over Penetration Depth If there is insufficient freezing power available, with the forming layers of ice that hinder penetration, the lower levels of the lesion will not be reached.

34. No control over the inclusion zone Cotton buds never fit well to the lesion resulting in inevitable inclusion of normal healthy tissue resulting in pain and blisters.

35. Definition of Cryotherapy Cryotherapy is the controlled destruction of unwanted tissue by the precise application of extreme cold.

36. Indirect Direct The use of Cotton Buds are indirectapplications. It will not bring control over the criteria essential for successful treatment with cryotherapy. By spraying Cryogen onto the tissue, the application will becomedirectwith significantly better control over those parameters known for good treatment profiles.

37. Cryotherapy with N2 spray In hospital settings, Dermatologists sometimes use LN pumps for direct application of Liquid Nitrogen onto the tissue

38. Cryotherapy with N2 spray • Better control over temperature • Better control over energy supply • However : • Minimal treatment zone : 10mm & more. The result is collateral damage and pain in all lesions smaller than 10mm. • You still need Liquid Nitrogen, which is not always easy to have in out-patient situations

39. Analysis of the traditional methods and how they can be improved With traditional cryotherapy methods, pain due to collateral tissue damage is not easy to avoid. Because of the pain experienced, patients will not allow for treatment long enough to penetrate deep enough, which leads to repeat visits.

40. Why pressure ?

41. Pinpoint Precision at -89°C, So easy to work with ...

42. Discover how this feature will create more Treatment Opportunities Treatsuccessfullyskinlesionsthatyoudid not treatbefore.

43. Even the smallest lesions can now be treated without collateral damage

44. Wart in Eyebrow

45. Tissue Necrosis after 5 days

46. Total Recovery after 3 weeks

47. The innovation of CryoPen Pinpoint Precision to the millimeter. No treatment of healthy skin. No pain. Patients will allow longer treatment with deeper penetration of freezing power. Time consuming repeat visits will reduce dramatically!

49. Practical/Technical Aspects Freezing Rate: 1 mm per 5 seconds. Maximum penetration:From 4 to 7 mm Depending on the volumetric flow rate by the choice of the relevant CryoPen Applicator

50. Wart on the face.