Cold urticaria as a complication of cryotherapy in the treatment of viral warts

Cryotherapy with liquid nitrogen has been established as the first-line treatment for pediatric patients with viral warts. Cold-induced urticaria (CU) is a rare skin reaction triggered by cold stimuli. We present the case of a pediatric patient with viral warts who developed CU after receiving cryotherapy.     

Cryotherapy of viral warts: a sustained 10-s freeze is more effective than the traditional method

BACKGROUND: Cryotherapy is a standard treatment for viral warts. Although textbooks recommend treating until there is a halo of ice around the wart (traditional freeze), many authors advocate more aggressive cryotherapy. There are no previously published studies assessing the efficacy of longer freezing times. OBJECTIVES: To compare the efficacy of the traditional freeze and a sustained 10-s freeze in the treatment of common viral warts with liquid nitrogen. METHODS: Patients attending a dedicated wart clinic were randomized to receive either a traditional freeze or a 10-s sustained freeze with liquid nitrogen delivered by a spray gun. Two hundred patients were recruited, 100 in each group. RESULTS: After five treatments, 49 patients in the 10-s freeze group were clear of warts (64% of non-defaulters) as compared with 31 (39%) of those in the traditional freeze group (chi2 = 6.7; P = 0.009). Seventy-four patients in the 10-s freeze group as compared with 59 in the traditional freeze group had either improved or cleared after five treatments (chi2 = 5.0; P = 0.02). Morbidity was significantly greater in the 10-s freeze group. Sixty-four patients suffered pain or blistering as compared with 44 in the traditional freeze group (chi2 = 10.8; P = 0.0045). Five patients were withdrawn from the 10-s freeze group because of pain as compared with one patient in the traditional freeze group. CONCLUSIONS: A 10-s sustained freeze is more effective in the cryotherapy of viral warts but carries a significantly greater morbidity in terms of pain and blistering.     

Different freezing time of superficial liquid nitrogen cryotherapy in treatment of recalcitrant alopecia areata: Randomized clinical trial

Recalcitrant alopecia areata is not uncommon in clinical practice and some patients experienced either treatment failure or recurrence with most of the conventional therapies. Several studies have evaluated the efficacy of cryotherapy in the treatment of alopecia areata with controversial results. This study aimed to optimize the ideal timing of liquid nitrogen cryospraying to achieve the most favorable results. A total of 75 patients with recalcitrant alopecia areata were treated with superficial cryotherapy, two freeze‐thaw cycles, each consisted of 3 to 5, 8 to 10, and 13 to 15 seconds in group A, B, and C, respectively. Good to moderate improvement was achieved in 65.2%, 76%, and 76.2% in groups A, B, and C, respectively, with no statistically significant difference. However, the mean percentage of improvement was significantly higher in group B and C compared to group A (P‐value < .05 for each). Superficial liquid nitrogen cryotherapy is an effective therapeutic modality for recalcitrant alopecia areata. Moreover, using 8 to 10 seconds dual freeze‐thaw cycles is the optimum timing.     

液氮冷冻与Q开关激光治疗脂溢性角化病的疗效比较

目的:比较液氮冷冻与Q开关激光治疗脂溢性角化病的临床疗效.方法:选取2017年6月至2020年2月间我科就诊的脂溢性角化病患者,随机分为液氮冷冻组和Q开关激光治疗组.结果:共治疗170例患者,其中液氮冷冻组85例245枚皮损痊愈238枚(97.14％),显效7枚(2.86％),总有效率为100％,治疗后6个月继发性色素...     

Intralesional immunotherapy of common warts: successful treatment with mumps,measles and rubella vaccine

Background Despite numerous therapeutic modalities reported in the literature, treatment of common warts remains a continuing challenge and there is no universal consensus about optimal treatment. Recently, intralesional immunotherapy by different antigens has proved efficacy in the treatment of different types of warts. Objective To evaluate the efficacy and safety of intralesional mumps, measles and rubella (MMR) vaccine in the treatment of common warts. Methods The study included 135 patients with single or multiple recalcitrant or non‐recalcitrant common warts. They were randomly assigned to two groups; the first group (85 patients) received intralesional MMR vaccine, and the second group (50 patients) received intralesional saline as a control group. Both treatments were injected into single lesions or largest wart in case of multiple lesions at 2‐week intervals until complete clearance or for a maximum of five treatments. Follow‐up was made every 2 months for 6 months to detect any recurrence. Results A highly significant difference was found between the therapeutic response of common warts to MMR vaccine and saline control group (P < 0.001). In the MMR group, complete response was achieved in 80% and 84.6% of patients presenting with recalcitrant and multiple warts respectively. No recurrence was observed in the MMR group and side effects included pain during injection and flu‐like symptoms. Conclusions Intralesional immunotherapy by MMR vaccine is a promising effective and safe treatment modality for common warts, particularly the multiple ones.     

Tolerability and effectiveness of liquid nitrogen spray cryotherapy with very short freeze times in the treatment of xanthelasma palpebrarum

Xanthelasma are cholesterol‐filled, soft, yellow plaques that usually appear on the medial aspects of the eyelids bilaterally. They are always benign lesions so therapy is usually undertaken only for cosmetic reasons. Surgical excision, chemical peeling with tricholoroacetic acid, and laser ablation are commonly used treatments. Liquid nitrogen cryotherapy is a potentially effective but rarely used treatment due to the risk of intense eyelid swelling. We report on our experience with four of our patients, and propose an explanation for the effectiveness of gentle liquid nitrogen spray cryotherapy in xanthelasma. We consider that gentle liquid nitrogen cryotherapy should be used in the treatment of xanthelasma due to the ease of application and low risk of adverse effects.     

A comparison of therapeutic efficacy of a melamine foam sponge and conventional cotton wool bud in the cryotherapy of viral warts: a paired comparison study

Many therapies have been studied for the treatment of viral warts, but none are uniformly effective. The aim of this study was to compare the efficacy of conventional cotton wool bud with that of melamine foam sponge as applicators in the treatment of warts with liquid nitrogen. A paired comparison study was conducted in 27 patients with at least two similar clinical types of warts. Similar clinical lesions were allocated to have liquid nitrogen applied with cotton wool bud or melamine foam sponge. Mean size reduction rate after the first treatment was 30.5% in the cotton wool bud group and 59.1% in the melamine foam sponge group. Mean number of total treatments was 3.05 in the cotton wool bud group and 2.29 in the melamine foam sponge group. Melamine foam sponge was found to be more effective in comparison to conventional cryotherapy with cotton wool bud.     

液氮深低温与浅低温冷冻疗法对皮肤温度与组织学影响的实验研究

进行了液氮深低温与浅低温冷冻疗法对皮肤温度与组织学影响的动物实验研究。结果证明，前者局部低温范围为－３５－－３６℃，是通过一系列理化方面的变化而破坏局部组织，达到治疗目的的一种方法；后者低温范围在－１－＋６℃，对组织及细胞无明显损伤，可使真皮浅层毛细血管扩张，数目增多，尤以毛囊周围为显著，从而改善了毛及其周围可使真皮浅层毛细血管扩张，数目增多，尤以毛囊周围为显著，从而改善了行情主其周围的血液循环和