Other indications and contraindications for the treatment of dermatological diseases with liquid nitrogen. Part 3

From this article you will learn:

• What is cryotherapy
• For what purposes is cryotherapy used in a beauty salon?
• What is the effect of cryotherapy
• What are the indications and contraindications for cryotherapy?
• How to care for your skin after cryotherapy

Beauty is made up of many factors. This includes spiritual purity, graceful body shape, and hair condition. But all this will fade into the background if the face is not beautiful, if pimples, constant oily shine or wrinkles appear on it. Modern women are very lucky, because there are a lot of cosmetic methods that can restore the pristine beauty of the skin in the shortest possible time. One of them is cryotherapy in a beauty salon. What kind of procedure is this? Let's figure it out.

Treatment of alopecia areata with cryotherapy

The content of the article

For focal alopecia, superficial freezing using the deep “Deep steak” method, contact method or spray method is used.

Freezing a swab immersed in liquid nitrogen combined with pressure is done by rolling it over the skin for about 5-7 seconds. Freeze by contact or spray method for 5-10 seconds. once or twice. Cryotherapy is repeated 1-2 times a week in 4-8 week cycles or every other day 15 times per cycle.

Treatment of alopecia areata with cryotherapy

The cycles should be repeated four times with monthly breaks. The results of cryotherapy for alopecia areata are encouraging. However, the procedures should be carried out very carefully, because even a short-term excessive drop in temperature can damage the hair follicles. So the “Deep steak” method remains the safest. You can also freeze areas of baldness with ethyl chloride 2 times a week (regrowth takes place after about 10-12 freezes).

Devices used to perform the procedure

For whole body cryotherapy, special cryogenic units with liquid nitrogen or refrigeration units are used. They are group and individual, open and closed. In all installations, alarm devices are installed for safety, internal coating without traumatic elements is used, temperature and humidity are controlled. The design allows the patient to freely open the door from the inside.

Cryogenic chambers, cryorooms

Closed group installations. They can be used by several patients at the same time, so they are larger and more expensive than individual capsules. Cooling down to -110C° is provided by liquid nitrogen or refrigeration machines.

Note!

Reference

Devices of the second type are characterized by energy intensity and the presence of complex elements. Cooling in them occurs more slowly than in installations with liquid nitrogen.

Two-stage cryogenic chambers

They consist of 1 to 3 cabins with different temperature conditions: -60C° and from -110C° to -160C°. They can be used by 3-5 people at the same time. Liquid nitrogen does not enter the chamber, but into heat exchangers, due to which the dry cold air remains transparent and allows the doctor to see the patient.

Cryosaunas, cryo-barrels

Individual open type devices. The patient is placed in a special cylindrical tank, while the face, arms and shoulders remain open. A session on such equipment can be performed by people suffering from claustrophobia. This installation is safer than a closed one, but it is difficult to maintain a constant temperature and cover the entire body. The advantage is the low cost of operation.

Important to remember!

Attention

Group open-type installations are called “cryopools”. Two people can undergo the procedure at the same time. Cooling - air, up to -85C°.

Cryocapsules

Individual closed installations with an opening for the patient's face to eliminate the risk of injury to the respiratory tract. They achieve uniform cooling from -130C° to -160C°. The safety of the procedure is ensured by automatic thermostats.

Devices for local cryotherapy

As a rule, these are compact devices that are used for local procedures. Main types:

1. Thermoelectric modules, Peletier elements - contact devices with cooling nozzles. Exposure temperature from +12C° to -10C° for long sessions, up to -35C° for short-term treatment.
2. Liquid nitrogen devices. Cooling occurs with a gas jet from +20C° to -180C°. These devices are used, among other things, for surgical operations.
3. Devices for air cryotherapy. Air is taken from the environment and cooled to -60C°.

Cryotherapy for acne vulgaris and rosacea

For acne vulgaris and rosacea, pustular, papular and larger cysts are suitable for cryosurgery. Blackheads cannot be treated with cold.

Best results are achieved using the 2-5 second spray method for small and superficial lesions, up to 5-20 seconds for larger cysts. Shallow lesions and cysts on the skin of the torso and chest respond best to treatment.

Using the Spray Method to Treat Acne Vulgaris and Rosacea

The same thing happens with rosacea. In the case of nodular changes in the nose (rhinophyma), due to their significant blood supply, in order to achieve sufficiently deep necrosis, it is necessary to spray the drug for about 20-40 seconds or repeat the treatment after two months. The mechanism of action of cryotherapy for acne is to cause atrophic changes in the skin appendages.

Patient reviews

Victoria, 25 years old

This “chilling” procedure was prescribed to me for demadecosis. The alternative that did not suit me was taking medication. I completed a course of 2 procedures per week. Now I do it once a month for prevention. I'm very pleased with the result! Among the disadvantages: unusual sensations from the cold.

Lyudmila, 56 years old

I removed a 10-year-old plantar wart with liquid nitrogen. It’s my own fault for waiting so long. The doctor warned that after the procedure it would hurt, but I didn’t think it would be so bad. The wart swelled up, and the pain was shooting. I took painkillers. The entire healing process took almost 3 weeks, but now there is no trace of the wart left.

Elena, 31 years old

I removed a mole on my face and was scared! It was difficult to heal for two months. There were even thoughts that the mole was malignant, and the doctor was mistaken. Moreover, his office was ancient. Now that 1 year and 5 months have passed, I have calmed down. There were no traces of the mole left. It was my own fault that it took a long time to heal - I didn’t follow the recommendations and picked at the treatment site.

Svetlana, 25 years old

Removed plantar warts. A cruel procedure. I also didn’t like that the cauterization site was not treated with anything: neither before nor after. I didn’t take any tests either; they only asked me for my address and full age. But in vain. I only remembered about my allergy to cold at home after cauterization. The first two days I didn’t sleep at all because of the pain. I no longer go for such procedures.

Yulia, 30 years old

I recommend everyone to try cryosauna at least once! I wore it after classes in the pool, and all my fatigue disappeared! It wasn’t cold, although they still put felt boots on me. I really liked the feeling of euphoria after the session. They later explained to me that cold stimulates the production of the pleasure hormone.

Treatment of granuloma annulare with liquid nitrogen

Treatment of granuloma annulare, which consists of freezing with ethyl chloride or snow paste, has been used for a long time. Spraying with liquid nitrogen for 20-30 seconds is less commonly used. Treatment can be repeated after 4 weeks. For lesions with a diameter of more than 3 cm, it is sufficient to freeze only the peripheral part. Rashes in the form of disseminated granuloma annulare cannot be treated with cryosurgery.

Granuloma annulare

For nodular prurigo, cryosurgical treatment results in rapid resolution of the lesions. The best effect is achieved when using applicators with a diameter corresponding to the size of the nodules, with double freezing in 15-45 seconds. However, the results of treatment are not permanent. The itching usually recurs after a few months.

Localized scabies is indicated for treatment by spraying the product repeatedly and freezing the surface without blistering, which results in short-term relief of symptoms and easier lesions.

Cryotherapy for lupus erythematosus

In lupus erythematosus, cryotherapy is particularly useful in treating the discoid form (DLE). The method can be used several times, with an interval of 7-14 days, lasting 2-5 seconds. Freezing is carried out with solidified carbon dioxide in the form of sticks or a mixture with ether or gasoline.

Liquid nitrogen is used less frequently.

Double freezing using the spray or contact method for 15-60 seconds also gives good results. Freezing too shallow promotes relapses. In large lesions with active lesions along the periphery, it is preferable to freeze only the marginal part with a spray.

Cryotherapy for DVE may be an alternative to intralesional corticosteroid injections, reducing itching and leaving flat, discolored scars. In some patients, this may prevent the development of tumors in the lesions.

Other indications for the use of cryotherapy methods in dermatology include: Mibelli porokeratosis, lichen sclerosis and atrophic lichen, cirrhosis of the penis, Passini-Pierini atrophoderma. and etc.

Cryosurgery is also used for the removal of ingrown toenails, tattoo removal, some tropical mycoses, cutaneous leishmaniasis, larva migrans infections, psoriasis, and the treatment of purulent skin conditions such as boils, carpal furuncles, strokes, and abscesses.

Contraindications to cryotherapy

When qualifying patients for treatment with this method, numerous general and local contraindications should be taken into account.

1. The coexistence of pathological formations, the exacerbation of which can be caused by local temperature changes:

• cryoglobulinemia;
• cryofibrinogenemia;
• cold agglutinin disease;
• cold erythema;
• inflammation of the subcutaneous tissue from cold;
• Raynaud's disease.

Cold erythema
2. Diseases and treatment procedures that prevent proper healing after freezing:

• connective tissue diseases and autoimmune diseases,
• multiple myeloma,
• thrombocytopenia,
• agammaglobulinemia,
• pyoderma gangrenosum,
• immunosuppressive treatment,
• dialysis therapy.

Taking into account the localization, it is not recommended to perform cryosurgery for changes:

• on the lower leg - due to prolonged healing,
• on the free edge of the wings of the nose and at the border of the labial red (especially the upper lip) - due to the risk of unsightly scars (this mainly applies to cases requiring deep freezing),
• into the ear canal - due to the risk of facial paralysis.

What effect should you expect from the procedure?

After a full course of procedures, you should not hope for rejuvenation for several years. A noticeable result is observed from cryoelectrophoresis, which is also called cryolifting, cryodembrasion and cryodestruction. Cryomassage provides a general healing effect, improving skin condition and complexion.

Results of facial cryotherapy:

• elimination of neoplasms, acne, dryness and flaking of the skin;
• reduction of wrinkles, jowls, double chin;
• restoration of skin firmness and elasticity;
• radiant complexion;
• disappearance of greasy shine;
• relieving swelling and inflammation.

Important to remember!

Attention

After cryoprocedures, redness and partial loss of sensitivity of the skin due to cold are possible. These are short-term phenomena that go away on their own.

Side effects and complications after cryotherapy

Their occurrence and severity depend on the depth of freezing, the location and size of the treated lesion.

Complications after cryotherapy are divided into:

• immediate;
• early;
• late;
• permanent.

Most direct reactions are always occurring phenomena. Their unexpected intensity should be cause for concern.

Immediate complications:

• Pain (17.8%) - can occur with any treatment, even when using the stick method. Re-freezing usually causes less discomfort. The pain intensifies during defrosting and can last up to several hours. It's like an aching ripple. Particularly sensitive areas are: fingertips, nail shafts, soles, ears, helix of the ear, lips and mucous membranes, temporal and frontal areas (due to the ease of irritation of the periosteum);
• Edema (7.9%) is considered a side effect if it affects the tissue surrounding the treated lesion and is negatively assessed by the patient. The area around the eyelids is most susceptible; After treatment of lesions in this area, swelling may appear in the upper cheeks, nose, forehead and front of the scalp. Other vulnerable areas: lips, foreskin, labia, especially small ones. Swelling after cryotherapy procedures is more common in children;
• Bleeding - may occur after cryotherapy with applicators covered by highly perfused vascular or cancerous granuloma nodes. There is also a risk of bleeding when treating lesions that have previously been biopsied or if part of the tumor has been cut before surgery;
• Excessive reaction in the form of blisters - especially painful when the soles are affected;
• Gas penetration into the subcutaneous tissue occurs in exceptional cases when ulcerative tumor foci are frozen by spraying or with a fresh biopsy defect, especially in the lower eyelids. It occurs with a characteristic “crackling” of exfoliating tissues;
• Fainting - most often occurs in young people as a neurovegetative reaction with a drop in blood pressure and increased sweating (especially if the procedure was performed with the patient in a supine or supine position);
• Infection after surgery - the greatest risk of secondary infection occurs in the case of difficult-to-heal ulcers after treatment of lesions located on the lower legs. Prevention of this type of complication involves irrigating the lesions with hydrogen peroxide, applying topical antibiotic dressings, or using antibiotics in general (especially after treating multiple lesions, such as actinic keratoses);
• Feverish reaction.

Feverish reaction
Other rare complications: cardiac arrest, formation of vascular granuloma at the site of freezing, etc.

Early complications:

• Post-inflammatory color changes (0.5%) - appear mainly in people with dark complexions. They may cover the entire freeze field equally or appear as a discolored field border. They are an epidermal symptom - a decrease in the number of melanocytes after cryotherapy is accompanied by their functional hyperactivity. The discoloration disappears after a few months;
• Milia (12%) - some patients have many of them around the perimeter of the freezing field.

Late complications:

• Nerve Damage—Cryosurgical procedures cause reversible impairments of pain, touch, and cold sensation that may persist for several months depending on the location of the affected area. These disorders last the longest and are most pronounced in scars on the trunk and limbs. Motor fibers may also be damaged after treatment at the superficial nerve site. Particular care is required when treating lesions located on the lateral surfaces of the fingers, in the area of ​​the angle of the jaw, in the jaw area, on the lateral parts of the tongue, in the fossa, on the back of the foot. The risk of nerve damage is reduced by using an anesthetic and folding the skin during freezing;
• Vascular granuloma;
• Pseudomalignant scar hyperplasia (1.3%) is a rare phenomenon that usually occurs after treatment of cancerous tumors or ulcers complicated by secondary bacterial infection. At the base of the atrophic scar, a dark red, linear, cohesive, raised body gradually grows, which may resemble a relapse. Places prone to this type of complications are: wings of the nose, upper lip (risk of disfigurement, tightening scar, especially after deep freezing), forehead, bridge of the nose, skin of the sternum, lower eyelid (risk of partial eversion of the eyelid). In exceptional cases, a keloid may form in the scar.

Permanent complications:

• Atrophic scar (2.7%);
• Eversion of the eyelids;
• Alopecia - deeper freezing of changes on the scalp causes persistent alopecia due to the high sensitivity of the hair follicles to low temperatures. Therefore, for cryosurgery it is necessary to carefully select lesions located along the edges of the hair on the forehead and temples, in the eyebrow area and on the skin of the chin in men;
• Color changes (6.9%) - their intensity depends on the duration of freezing. After approximately 6 months, re-pigmentation depends on the migration of melanocytes from the periphery. At this time, it is necessary to apply UV protection measures.

Despite the possible occurrence of the complications described above, cryosurgery still remains the method of choice for the treatment of many diseases in dermatology. Its undoubted advantages:

• relatively low cost of treatment;
• a small percentage of side effects;
• usually does not require anesthesia;
• fast healing;
• very good cosmetic effects;
• the possibility of use in areas that are less accessible to other treatment methods or that are a contraindication to their use;
• the possibility of re-treatment and use in case of ineffectiveness of other treatment methods.

Cryotherapy should be considered as a safe, effective, technically fast and simple method of treatment, allowing the treatment of many dermatoses and a large number of patients in an outpatient setting.

Indications

There are no strict age or gender restrictions for cryotherapy. However, there must be a reason for its use, because this procedure has contraindications and side effects. Facial cryotherapy is performed for patients over 5 years of age with the following problems:

• moles, warts, papillomas and other benign skin tumors;
• oily skin, enlarged pores, acne;
• fine wrinkles;
• initial gravitational ptosis;
• dermatitis, eczema;
• scars;
• anemic skin;
• dull complexion;
• swelling, inflammation after operations and cosmetic procedures.

Sources

• Markevich T.: Indications for the use of cryotherapy, 1994;
• Kanmerovsky M.: Cryosurgery for skin diseases, 1997.
• Bembenek M., Zhaka M.: Cryosurgery in the palliative treatment of malignant melanoma, 1997;
• Broniarczyk-Dila G., Janowski P.: Cryotherapy and its use in skin diseases, 1997;
• Jakubiak A.: Use of cryotherapy in the treatment of certain skin diseases, 1990;
• Kashuba A. et al. Cryotherapy with nitrous oxide in dermatological practice, 1995;
• Lis A. et al.: The influence of cryo-application time using liquid nitrogen on the effectiveness of treatment of basocellular epithelioma, 1997;
• Machonko T et al.: Treatment of alopecia areata with liquid nitrogen, 1981;
• Shmurly V. et al.: Cryosurgery. Methods and Applications, 1989.

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Reviews from cosmetologists

Varvara Zaitseva, dermatocosmetologist

My experience shows that cryotherapy is a good, proven method that is suitable for most patients. Of course, it has its contraindications, for example, rosacea and allergies to cold, but they are not so common. Cryotherapy is available and has a wide range of applications.

Svetlana Kovaleva, dermatologist

The safety issues of cryotherapy are not all smooth sailing. The method with cotton wool wound on a wooden stick violates the principle of “small dosages”. In addition, it is carried out by people who sometimes do not have higher medical education. Hardware methods using mini-thermoses with flat attachments do not take into account the relief of the face. I believe that modern pharmaceutical cosmetics solve the same problems as cryotherapy, but are safer than the old-fashioned “freeze and forget” method.

Marina Garbuzova, dermatocosmetologist

The disadvantages of cryotherapy that are talked about are associated, in my opinion, with the unprofessionalism of cosmetologists. Today, there are hardware techniques for both general and local effects. Proper use of such equipment reduces the risk of complications.

Vladimir Marenich, PhD, plastic surgeon

Cryotherapy as a separate procedure is ineffective and can only be used in combination with other techniques. A short-term rush of blood does not produce serious aesthetic results. The advantage of this procedure is that it is quite harmless and can be performed without higher medical education.

Natalya Norenkova, dermatologist

I am for cryotherapy. Cryodestruction of warts leaves virtually no scars or marks. The result of cryodermabrasion is similar to the effect of chemical peels, but the procedure itself is safer. Cryoaerotherapy is indispensable after liposuction, plastic surgery, hair removal, resurfacing to relieve pain, swelling and redness.