CryoPen Cryotherapy for Verrucae

What is CryoPen cryotherapy?

Cryotherapy means treating tissue using a very low temperature.

CryoPen is a specialist cryosurgical device that allows your podiatrist to accurately freeze the verruca while limiting treatment of the surrounding healthy skin.

Verrucae are caused by the human papillomavirus (HPV). Freezing damages the affected verruca tissue and creates a local inflammatory response. Over time, the treated tissue is removed as the skin heals.

Why has cryotherapy been recommended?

Cryotherapy is a well-established treatment option for verrucae and may be considered when a verruca is persistent, painful, spreading or has not responded adequately to simpler treatments.

It may also be recommended because it:

• is performed during a relatively short appointment
• does not normally require an injection or local anaesthetic
• precisely targets the verruca
• can be repeated where required; and
• usually allows you to continue normal daily activities.

Your podiatrist will have considered the appearance, location and extent of your verruca(e), previous treatments and your general health when recommending cryotherapy.

What happens during treatment?

Your podiatrist will first examine the verruca.

Plantar verrucae often develop a layer of hard skin over them. Where appropriate, this will be carefully reduced or debrided before treatment to allow the freezing treatment to reach the affected tissue more effectively.

The CryoPen applicator is then positioned over the verruca and the area is frozen for a controlled period.

The skin usually becomes temporarily white or frozen in appearance before gradually returning towards its normal colour as it thaws.

Depending on the size and thickness of the verruca, your podiatrist may use more than one freeze during the appointment.

Where you have several verrucae, all appropriate lesions can be treated during the same appointment.

Local anaesthetic is not normally required.

What does cryotherapy feel like?

Cryotherapy can be uncomfortable.

During freezing you are likely to experience a cold, stinging, burning or painful sensation. This usually lasts for a relatively short period, although the area may remain tender afterwards.

The amount of discomfort varies considerably between patients and also depends on the size and location of the verruca and the intensity of treatment required.

How many treatments will I need?

Verrucae respond differently between patients and several treatments may be required.

At The Podiatry Clinic, cryotherapy is usually repeated approximately every 2–4 weeks, depending on how the skin and verruca respond.

A course of up to approximately 6 treatments may be considered where clinically appropriate.

Your podiatrist will review the response throughout the course rather than automatically continuing treatment if the verruca is not responding adequately.

Cryotherapy is an established treatment for verrucae, but research has not shown it to be consistently superior to other conventional treatments for plantar verrucae. Some verrucae respond well, while others can remain resistant despite repeated treatment.

As with all verruca treatments, complete clearance cannot be guaranteed.

What happens after treatment?

The treated area may feel sore or tender for a short period after cryotherapy.

The skin may become:

• red
• tender
• slightly swollen
• darker or lighter in appearance; or
• blistered.

A blister can sometimes develop several hours after treatment. It may contain clear fluid or occasionally blood. This is a recognised response to freezing and does not necessarily mean something has gone wrong.

Most patients can continue walking and normal daily activities, although a plantar verruca may feel uncomfortable under pressure for a short period.

If a blister develops, try to keep it clean, protected and intact where possible. Do not deliberately burst or remove the overlying skin.

Your podiatrist will advise you if a dressing or additional aftercare is required.

What are the potential benefits?

Potential advantages of CryoPen cryotherapy include:

• a well-established treatment approach
• treatment delivered directly to the verruca
• relatively short treatment sessions
• no local anaesthetic in most cases
• treatment of several appropriate verrucae during the same appointment; and
• little disruption to normal activities for most patients.

Some verrucae respond very well to freezing. However, plantar verrucae can be particularly resistant and the response varies considerably between individuals.

What are the possible side effects and risks?

Cryotherapy intentionally freezes and damages the targeted skin tissue, so some local reaction is expected.

Common temporary effects include:

• pain or tenderness
• redness and swelling
• blistering
• blood blister formation; and
• temporary changes in the appearance of the treated skin.

Less commonly, cryotherapy can result in:

• a larger or more painful blister
• skin breakdown or a small wound
• infection
• delayed healing
• temporary or longer-lasting changes in skin pigmentation
• altered sensation or nerve irritation; and
• scarring.

More intensive freezing may increase both the treatment effect and the likelihood of pain, blistering and other local side effects.

There is also a possibility that the verruca may not completely clear, may recur after treatment or may require an alternative treatment.

Is cryotherapy suitable for everyone?

Cryotherapy is not suitable for every patient or every verruca.

Particular caution is required where there is poor circulation, reduced sensation or impaired healing, including some patients with diabetes or peripheral vascular or neurological conditions.

The condition of the surrounding skin and the location of the verruca also need to be considered.

Cryotherapy can be painful and may cause blistering. For this reason, its suitability for children and young people is considered individually, taking into account the child's age, the location and size of the verruca and their ability to tolerate treatment.

Your podiatrist will assess whether cryotherapy is appropriate for you before treatment.

If your health, medication or the condition of your foot changes during your treatment course, please tell your podiatrist before your next treatment.

What are the alternatives?

There are several approaches to managing verrucae and no single treatment is appropriate for everyone.

Depending on your individual circumstances, alternatives may include:

• monitoring the verruca without active treatment
• appropriate home or topical treatments
• Verrutop
• Swift microwave therapy
• Class IV laser therapy; or
• verruca needling (Falknor's needling).

If your verruca is not responding adequately, your podiatrist can discuss whether continuing cryotherapy or changing treatment would be more appropriate.

How much does CryoPen treatment cost?

CryoPen cryotherapy: £65 per treatment

Several sessions may be required. Your podiatrist will review your progress throughout your treatment course.

When should I contact the clinic?

Some tenderness, redness and blistering can be a normal response following cryotherapy.

Please contact the clinic if you develop:

• severe or worsening pain
• significant or rapidly increasing swelling
• spreading redness or warmth
• discharge or other signs of infection
• a large or troublesome blister
• unexpected skin breakdown; or
• any other reaction that concerns you.

Please also tell us about any significant change in your health or medication before your next treatment.

Your next step

If you have already booked your treatment

There is normally nothing further you need to do.

Please read this information before attending your appointment. Your podiatrist will review the verruca and confirm that cryotherapy remains appropriate before treatment.

If you have any questions or concerns, please discuss them with your podiatrist before treatment begins.

If cryotherapy has been recommended but you have not yet booked

You can book your Nails, Skin & Verruca – Follow-Up appointment when you are ready to proceed.

CryoPen cryotherapy: £65 per treatment

Important information

This information sheet is intended to support the discussion you have had with your podiatrist and help you make an informed decision about treatment. It does not replace individual clinical advice.

Verrucae can be persistent and treatment outcomes vary between patients. Complete clearance cannot be guaranteed.

Before treatment, your podiatrist will confirm that cryotherapy remains appropriate for you and you will have the opportunity to ask questions or discuss any concerns before deciding whether to proceed.

The Podiatry Clinic