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  • • Parent’s or child’s desire for office-based treatment.


  • • Child unable to undergo painful procedure.

    • Some physicians consider verruca in a periungual location a contraindication to destructive therapies (nail matrix damage may occur and result in permanent nail dystrophy).

    • History of keloidal scarring.

  • • Dipstick method.

    • • Liquid nitrogen (–195.8 °C).

      • Cotton-tipped applicators.

      • Cotton balls.

      • Styrofoam cup.

      • Extra cotton can be rolled onto cotton-tipped applicators.

    • Spray devices

    • • Cryospray canister filled with liquid nitrogen.

      • Children may be afraid of these spray canisters and often have less anxiety with the dipstick method.

  • • Treatment causes blistering and rarely scarring.

    • Temporary hyperpigmentation or hypopigmentation.

    • Hypertrophic or keloidal scarring is rare.

  • • Pretreatment of the area with paring or salicylic acid may decrease the wart hyperkeratosis and increase the treatment success rate.

    • Pretreat for pain with acetaminophen or ibuprofen 1 hour before the procedure.

    • The goal of treatment is tissue destruction through skin blistering.

  • • For the first week, there will be a blister that may be hemorrhagic that turns into a scab or crust, which comes off in approximately 2 weeks. The area can be cleaned with soap and water and covered with a topical antibiotic ointment and a bandage.

    • There are no limitations on physical activity unless pain results from the activities.

    • Acetaminophen may be required for the first 1–2 days after treatment for discomfort.

    • Several treatments are often needed.

  • • Patient should be positioned so that physician has close access to lesions.

    • Good lighting is helpful.

  • • Cotton-tipped applicators should be placed in a cup of liquid nitrogen until thoroughly soaked.

    • Apply to wart until white frost develops approximately 2 mm around the wart (Figure 38–1).

    • • A freeze-thaw cycle (time when wart becomes frozen white until return of pink skin) of 20–30 seconds is suggested.

      • Wart should be kept frosted for 10–15 seconds to obtain a 20 second freeze-thaw.

    • Freeze-thaw times from spray devices are the same as for the cotton applicators.

    • An adequate freeze-thaw time is easy to estimate with time and experience.

Figure 38–1.

Application of liquid nitrogen to wart.

  • • Pain is expected and can be treated with acetaminophen or ibuprofen.

    • Although rare, secondary bacterial infection of the blistered area can occur.

  • • Most young children will not tolerate the discomfort of this therapy.

    • Over-the-counter topical salicylic acid products with or without tape occlusion can be used if cryotherapy is not tolerated.

  • • Treatment can be repeated approximately every 3 weeks when the old blister peels off.

Graham GF. Cryosurgery. In: Robinson JK, Arndt KA, LeBoit P, Wintroub BU. Atlas of Cutaneous Surgery. Philadelphia: WB ...

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