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TIDBSI: Cryotherapy

Justin McCarthy, MD and Paul Simmons, MD
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19:42
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No me gusta!

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To freeze or not to freeze, that is the question that Drs. Paul Simmons and Justin McCarthy will attempt to answer in this Things I Do But Should I? conversation on cryotherapy. 

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ralph m. -

I typically have patients return in 2-3 weeks for re treatment but is there a different time frame to consider? Do you have patients with warts return the same time you would patients with benign or premalignant lesions that don't resolve with initial cryo?

Neda F., MD -

Hi Ralph! Here's Paul's reply:

Thanks for the question, Ralph!

Your 2-3 week window is totally reasonable - as I often say, every treatment in medicine takes about 2 weeks. :-) The main difference with wart cryotherapy is that I try to set the patient's expectations that they WILL be returning for 2 or more repeat treatments until the wart is gone. Other lesions often resolve with one treatment. But warts (especially plantar warts!) usually require repeat debridements and cryo treatments.

PDS

Kimberly B. -

This was very interesting because I was taught the three cycle technique. But I am having a hard time feeling OK with one cycle. I have always explained to my patients the three cycle technique in terms of frostbite. If you get frostbite you are not supposed to thaw it out if there is a chance of refreezing, because it is the refreezing that really causes the significant damage to the tissue. So, the three cycle technique (or two and parentheses, always made sense to me. Do you really feel that the evidence goes against doing it this way?

Neda F., MD -

Hi Kimberly. Here is Paul Simmons' response:

Hi, Kimberly:

Justin and I were both trained exactly how you were - three cycles - which is why the actual evidence that was available was kind of a shock to us. Your physiologic reasoning (the frostbite analogy) is tempting. But! We have to be careful with physiologic reasoning, don't we? Medical history shows us again and again how it sometimes doesn't hold up when tested. Not that cryo is some super-dangerous intervention, and you're probably not doing harm with the three-freeze technique. But yes, much to our chagrin, Justin and I think that the best evidence, as we now have it, supports a one-and-done cryo approach.

Freeze on!

Paul

Carmen V. -

Hello!
I tried accessing the table in your show notes and the link is not working. Can it be reposted?
Thank you
Carmen Vandal

Neda F., MD -

Thanks for letting us know, Carmen. Here you go, and we'll update the main page as well:
https://www.racgp.org.au/afp/2017/may/optimising-cryosurgery-technique/

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Hippo Primary Care RAP September 2020 Summary 658 KB - PDF

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