This supplement is published by the BDNG Dermatological Nursing, 2011, Vol 10, No 2 (suppl)

1. This supplement is published by the BDNG Dermatological Nursing, 2011, Vol 10, No 2 (suppl)

2. Cryotherapy – Introduction Cryotherapy: • the destruction of skin lesions • using a cold substance • most commonly liquid nitrogen LN2(-196°C; -321°F) • destruction is selective, affecting tissue only • induction of an effective immune recognition of viral or tumor cells

3. Cryotherapy - Indications Treatment of: • Benign lesions • Premalignant lesions • Malignant lesions

4. Cryotherapy - Contraindications There are no absolute contraindications Caution is needed when treating the following conditions:

5. Cryotherapy - Equipment The equipment required depends on the method and technique used Methods: • Open spray - 40̊C • Cotton bud - 20̊C • Metal forceps - 15̊C

7. Cryotherapy - Methods Spray: Spot freeze most commonly used for lesion up to 2cm diameter If lesion is over 2cm diameter use paint brush or rotary/spiral technique Include rim of normal tissue

8. Cryotherapy - Techniques Following the freezing the lesion must thaw fully as this is part of the cell destruction • Spray – 1cm distance from lesion • Freeze time starts from when the area is white • Once ice has developed continue for an appropriate time of 5-30 seconds intermittently A freeze / thaw cycle is used

10. Cryotherapy - Procedure

11. Cryotherapy - Procedure

12. Cryotherapy - Procedure • Only suitable for small, • superficial lesions • Useful when treating • young children

13. Cryotherapy - Procedure

14. Cryotherapy - Documentation

15. Cryotherapy - Indications

16. Cryotherapy - Viral Warts

17. Cryotherapy – Viral Warts Viral warts: Infection of the epidermis Human papilloma virus (HPV) Treatment: Either with spray or cotton bud A bud should be used on the face Two freeze thaw cycles are recommended

18. Cryotherapy – Skin Tags Skin Tags: Common, soft, harmless lesion of collagen and blood vessels Treatment: Forceps method or spray method For spray method hold tag away from skin and freeze through the base of tag

19. Cryotherapy – Seborrhoeic Warts Seborrhoeic Warts: Common benign lesions often starting in adulthood Warty, waxy, stuck on appearance

20. Cryotherapy – Molluscum contagiosum Molluscum contagiosum : Small (1-5mm) lesions caused by pox virus infection of the skin Common in : Atopic eczema Immunocompromised patients Children Treatment: Spray method

21. Cryotherapy – Sebaceus Hyperplasisa Sebaceous Hyperplasisa : Enlarged sebaceous glands Common in : Middle aged or elderly patients Immunocompromised patients Torré-Muir syndrome - sebaceous gland tumor Treatment: Spray method

22. Cryotherapy – Millia Millia: Tiny, superficial, keratin filled epidermal cysts Common in : Infants and adults Congenital or acquired Can result from physical trauma Sebaceous or sweat duct plugging Treatment: Spray method

23. Cryotherapy – Actinic/Solar Keratoses Actinic kerartosis: Hyperkeratotic lesion, chronic sun damage Pink, scaly, warty or crusted lesion Common in : Adult skin Light skinned individuals Treatment: Spray method

24. Cryotherapy – Bowen’s disease Bowen’s disease: Persistent, non-elevated, red, scaly or crusted plaque Has small potential for invasive malignancy to SSC Can grow several cm in diameter Common in : Elderly patients Lower legs Treatment: Spray method

25. Actinic Cheilitis BCC Actinic Cheilitis Superficial BBC

26. Cryotherapy – Side effects • Pain • Oedema/Blister • Ulceration • Nerve/tendon damage • Pigment change • Scarring • Infection • Urticaria

27. Cryotherapy - Safety Precautions Storage Liquid nitrogen should always be stored in a well ventilated room. Personal protective equipment When decanting liquid nitrogen non absorbent insulated gloves and a full face visor should be worn. Open toed shoes should not be worn Transportation If liquid nitrogen is to be transported in a vehicle, the driver must be aware of potential hazards, Especially asphyxiation, and know what to do in the event of an accident or emergency (BOC, 2004). It should only be transported where the load space is separated from the driver and passenger compartment. Liquid nitrogen containers should be • transported in a secure upright position • in a well-ventilated area (BOC, 2004).

28. Cryotherapy - Safety COSHH regulations apply Hazards include: • Asphyxiation in poorly ventilated areas • Chronic burns • Cryogenic burns / frost bite • Hyperthermia Wear protective equipment when handling Emergency action: Inhalation: • Remove individual from area • Do not place yourself at risk • Breathing apparatus may be used • Keep individual warm Skin/Eye contact: • Immerse affected area in tepid 42-45°C for at least 15min and cover with dry, sterile dressing

29. Cryotherapy – also covers… • Medicolegal aspects • Appendix 1: Assess competency according to WASP framework • Appendix 2: Methods for removal of keratin • Appendix 3: Check list for cryotherapy

30. Dermatological Nursing, 2011, Vol 10, No 2 (suppl) BDNG Tel: 020 7681 6131 www.bdng.org.uk