Removing Seborrheic Keratosis With Liquid Nitrogen

The use of cryogens otherwise known as cryotherapy, curettage, laser therapy, electrocautery or surgical excision all assist in treating seborrheic keratosis –  cryotherapy is the second-most common treatment after surgical procedures such as skin excision as it can quickly be carried out in the doctor’s clinic.

To get rid of bothersome types of skin lesions for example warts, actinic and seborrheic keratosis, cryotherapy utilizes extreme cold to freeze the lesions with liquid nitrogen, they then dry and peel off from the skin. Due to unsuccessful trials in removing deeper and thicker lesions, this regimen is recommended only for superficial or flat lesions.

Now, let us try to understand the mechanism of cryotherapy! Cryotherapy constricts the blood vessels at the site of the injury or in the case of keratoses, at the lesions’ site. This vasoconstriction (the medical term for constriction of the blood vessels) reduces the blood flow into the site. Oxygen supply, along with other important nutrients needed for a cell’s survival, decreases due to insufficient blood supply. Eventually, the desired effect is cell death or necrosis.

There are a few kinds of cryogens, substances used to obtain very low temperatures, namely, liquid nitrogen, carbon dioxide snow and DMEP or dimethyl ether and propane. Due to its efficiency in removing skin lesions, mainly because of its low boiling point, most physicians prefer to use liquid nitrogen when administering cryotherapy.

To begin the treatment, the physician directly applies the liquid nitrogen onto the seborrheic keratosis using a cotton-tipped applicator, a cryospray or a cryoprobe. In the span of a minute, heat from the skin transferring to the liquid nitrogen makes it disappear instantly. After this brief period of freezing comes the thawing of the lesions. Then when the cell’s contents leak out into its surroundings called the interstitial space, rest assured the cryotherapy has started the process of cell injury. To conclude the process, the client’s skin will show signs of inflammation – redness, swelling, pain and warmth – signaling the cells’ decompensation.

Cryotherapy, in general, is safe when carried out properly. But like many other procedures, complications can and will arise in some cases. Such is the effect of prolonged freezing by the liquid nitrogen which shows as a whiter skin color of the area treated than the surrounding skin, commonly referred to as hypopigmentation.

Although not listed as a hazardous material under the Resource Conservation and Recovery Act, liquid nitrogen is considered a highly dangerous chemical because any direct contact with it, especially prolonged contact, will result in rapid freezing and eventual tissue damage. People are exposed to liquid nitrogen either through inhalation or through direct contact. Inhalation effects are not that toxic unless a significant amount of liquid nitrogen is spilled, thereby reducing oxygen levels prompting the need for respirators. Extreme care must therefore be observed during its transportation.

Liquid nitrogen can spatter into one’s eyes especially when transferring it to another container. Or there can be accidental direct contact with the skin.

In conclusion, be it health professionals or the public, they must deal with liquid nitrogen safely. Goggles, face shields, masks, gloves, aprons and other encapsulating suits should always be your first line of defense from liquid nitrogen. People not having the first line of defense from liquid nitrogen should leave an area exposed to leaks. In cases of direct contact, soak the skin in water that has a temperature of 41-46 degrees Celsius then consult a doctor.

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