Emerging Concepts In Cryosurgery For Wart Treatment

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Author(s): 
Jerome Slavitt, DPM

   While warts are among the most common pathological problems that podiatrists treat, they are also among the most frustrating conditions. While there are multiple forms of therapy available, the success rate is not what we would like to see. In my clinical experience, I have found that these modalities only have an average cure rate of 75 percent.

   There is no individual approach that can be construed as the single most effective form of wart therapy. It is also a good idea to inform the patient about the possibility of recurrence both during and after the treatment procedures. Additionally, new lesions may develop during the treatment process.

   One can tailor the treatment plan to the needs of the specific patient. Warts can occur in children, young adults and adults, all of whom have specific needs. We should consider how a specific treatment may affect daily activities. The physician must know the answer to the question, “Will the patient follow instructions as they apply to the chosen treatment plan and comply with my directives?”

Assessing The Viability Of Treatment Options And Patient Adherence

Current treatment modalities include topical acids, surgical procedures (blunt curettage), various laser therapies, multiple forms of cryosurgery, oral medications, injection therapy, immunotherapy and electrocautery.

   Additional considerations are based on the number of warts and locations. A single wart has the highest cure rate while the mosaic variety has a high rate of recurrence. The patient’s age also dictates treatment parameters. It is difficult to approach the younger child with the idea of surgical removal with the understanding that a local injection for anesthesia will be required.

   Also bear in mind that athletes may find it difficult to keep the involved areas clean and dry for several days following acid therapies. With the reduction in insurance reimbursement and specific size criteria, outpatient hospital or surgery center laser therapy may not be a treatment option.

   I generally present my patients with three options for treating warts. The patient with a more involved condition may require more sophisticated treatment plans. Topical acid therapy after surgical debridement will require the patient to keep the involved area clean and dry for two days and return every two weeks for treatment until the condition resolves. Surgical blunt curettage is a second option but one must be selective in utilizing this approach with regard to the patient’s age, mental condition and the size of the lesions. The third option for many years was laser surgery.

   However, cryosurgery, which is more of an office-based procedure, has now become my primary treatment of choice.

A Closer Look At How Cryosurgery Works

Physicians have employed cryosurgery for many years for the treatment of warts. Cryosurgery methods range from a large “Q-Tip” type applicator dipped in liquid nitrogen to the more sophisticated cryosurgery units now available.

   There are key precautions to keep in mind when considering the use of cryosurgery for suspected warts. Physicians must rule out the possibility of melanomas, recurrent basal cell carcinomas and pigmented cells in their differential diagnosis. Other conditions one should consider are chronic inflammatory disease, chronic infections, neoplasms, diabetes and peripheral vascular disease.

   Cryosurgery has a specific mode of action with the selective destruction of identifiable lesions. It causes cryogenic cell death by extreme cold temperatures. A major benefit of cryosurgery is the preservation of the tissue matrix, which is relatively cold resistance and therefore allows for proper cosmetic healing with minimal scarring. The destroyed tissue sloughs off and reepithelialization occurs.

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