Cryotherapy

This involves the destruction of tissues by extreme cold. Current methods used are:

Carbon dioxide

Solid carbon dioxide (temperature —64 °C) is produced by allowing rapid expansion of the compressed gas from a cylinder. This can be mixed with acetone to form a slush that can be applied with a cotton wool bud. A solid carbon dioxide stick, for direct application to lesions, is produced by an apparatus using "sparklet" bulbs.

The lesion must be frozen solid with a 1-2 mm margin of surrounding tissue. After thawing the freezing cycle should be repeated.

This can be simply applied using a cotton wool bud dipped in the vacuum flask of liquid nitrogen. Freezing takes a little longer than using spray apparatus. Various types of such apparatus are available with different sizes of nozzle. The larger ones are used for seborrheoic keratoses on the back, for example, and the smaller sizes for small lesions on the face. Freezing takes a few seconds and after thawing a further application can be made if necessary.

Ethyl chloride

This is sprayed directly on the skin, producing lowering of the temperature and temporary analgesia. It is not generally used for treatment.

Nitrous oxide

A cylinder of compressed gas is used to cool a probe to approximately —80 °C. It is usually used for the treatment of warts and requires a 30 second freezing cycle.

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