1. Wouldn’t it be nice to improve the quality of skin lesion treatment ?

2. Agenda Wart and Skin Lesion Treatment Modalities What is Cryotherapy?
Traditional application of Cryotherapy
The innovation of CryoPen.
How to apply.

3. Warts
Warts are most common on the hands, feet or genitals. They are caused by HPV-infections and are commonly known as Verrucae Vulgaris.

4. Why should warts be treated quickly ?
When small, a wart is more easily removed.
When removed, a wart will no longer be the origin of further spread.
Prevention
and service
to patients…

5. Cosmetic lesions
Removing cosmetic skin lesions is becoming increasingly common as we all aspire to be attractive and stay youthful as we age.
Wouldn’t it be nice to improve your treatment modality for these lesions.

6. Family Physicians in General Practice
My Patients have no Warts.
I don’t treat Warts or Skin Lesions.
I treat Warts with a variety of alternatives to Cryotherapy because of no Liquid Nitrogen available.
I send my Patients to the Pharmacy.
I send my Patients to the Dermatologist.

7. How do Dermatologists perform Wart/Skin Lesion Treatment ?
Dermatologists usually treat Warts and Skin Lesions by freezing this tissue.
Cryotherapy is called the golden standard for Skin Lesion Treatment in Medical Practice.

8. What are the alternatives ?
HF-surgery and laser
Disadvantages;
Pain – Anaesthesia required
Risk of collateral damage.
Risk of depigmentation, mainly in darker skin
Scars easily.

9. Why Cryotherapy ?
Literature confirms that Cryotherapy is the practical, fast and primary form of treatment for Warts. Preparation and follow-up care are minimal to non-existent.
If correctly applied, it is well tolerated by children and adults.

10. Definition of cryotherapy
“Cryotherapy is the controlled destruction of unwanted tissue by the precise application
of extreme cold.”

11. Plantar Wart

12. First freeze 30 sec, same session second freeze 30 sec
Immediately after Treatment

13. Aseptic Necrosis of the treated tissue shows within 3 days.

14. 7 to 10 days after the Treatment the scab will disintegrate.

15. Healing is complete after 3 to 6 weeks.

16. Wart on hand

17. Necrosis of the tissue within 7 Days.

18. The crust has disintegrated and the tissue will fully regenerate within the next few weeks.

19. Healing is complete after 3 to 6 weeks.

20. The advantages of Cryotherapy
Sterile procedure: No excision, no risk of infection.
No pain treatment: no need for local anaesthetic.
Fast procedure: Follow-up care not necessary.
Safe: no damage from overenthusiastic use.
Speed of operation.
Excellent results.

21. Are these claims confirmed in daily practice?
No blisters, no pain?
Always good results?
Will one or two treatments cure the lesion?
Definitive result?

22. Cryotherapy
The success/result of Cryotherapy Treatment will depend on the level of the user’s expertise.
What are the criteria for successful Treatment?

23. Cell structure Cell membrane Nucleus Intracellular fluid
Extracellular fluid

24. Osmose: Principle of Cell Preservation
At slow freezing rates cells are given time for self protection.
Slow freeze
Fast thaw
Intracellular fluid
Nucleus
Cell Membrane
Extracellular fluid

25. Principle of Cell Destruction
Intracellular fluid freezes, tiny spiked shards of ice are
formed, cell membranes rupture, which will be the cause of Cell Destruction.
Fast freeze
Slow thaw
Intracellular fluid
Nucleus
Cell Membrane
Extracellular fluid

26. Effective cryonecrosis from -27°C
It is described extensively in literature that:
“rapid freezing to minus (-) 27°C and more will produce cryonecrosis in all human tissues”.

27. Why second freeze after 30 seconds?
When freezing is too slow, extracellular ice formation occurs, which has the effect of insulating cells and preserving them rather than the desired opposite.

28. Key criteria of cryonecrosis
Rapid freeze, slow unassisted thaw
Fast lowering of the temperature from +37°C to -27°C
TWO freezing cycles in ONE treatment session
Enough freezing power should be available to reach the bottom of the wart.

29. Traditional Cryotherapy treatment
Application with a cotton bud soaked with Liquid Nitrogen 29

30. A hassle to store and to refill

31. No control of energy transmission
Cotton buds will rapidly lose energy

32. No control over temperature
No control over energy =
No control over temperature

33. No Control Over Penetration Depth
If there is insufficient freezing power available, with the forming layers of ice that hinder penetration, the lower levels of the lesion will not be reached.

34. No control over the inclusion zone
Cotton buds never fit well to the lesion resulting in inevitable inclusion of normal healthy tissue resulting in pain and blisters.

35. Definition of Cryotherapy
Cryotherapy is the controlled destruction of unwanted tissue by the precise application of extreme cold.

36. Indirect Direct The use of Cotton Buds are indirect applications.
It will not bring control over the criteria essential for successful treatment with cryotherapy.
By spraying Cryogen onto the tissue, the application will become direct with significantly better control over those parameters known for good treatment profiles.

37. Cryotherapy with N2 spray
In hospital settings, Dermatologists sometimes use LN pumps for direct application of Liquid Nitrogen onto the tissue

38. Cryotherapy with N2 spray
Better control over temperature
Better control over energy supply
However :
Minimal treatment zone : 10mm & more.
The result is collateral damage and pain in all lesions smaller than 10mm.
You still need Liquid Nitrogen, which is not always easy to have in out-patient situations

39. Analysis of the traditional methods and how they can be improved
With traditional cryotherapy methods, pain due to collateral tissue damage is not easy to avoid.
Because of the pain experienced, patients will not allow for treatment long enough to penetrate deep enough, which leads to repeat visits.

40. Why pressure ?

41. Pinpoint Precision at -89°C,
So easy to work with ...

42. Treat successfully skin lesions that you did not treat before.
Discover how this feature will create more Treatment Opportunities
Treat successfully skin lesions that you did not treat before.

43. Even the smallest lesions can now be treated without collateral damage

44. Wart in Eyebrow

45. Tissue Necrosis after 5 days

46. Total Recovery after 3 weeks

47. The innovation of CryoPen
Pinpoint Precision to the millimeter.
No treatment of healthy skin.
No pain.
Patients will allow longer treatment with deeper penetration of freezing power.
Time consuming repeat visits will reduce dramatically!

49. Practical/Technical Aspects
Freezing Rate: 1 mm per 5 seconds.
Maximum penetration: From 4 to 7 mm
Depending on the volumetric flow rate by the choice of the relevant CryoPen Applicator

50. Wart on the face.

51. Necrosis of tissue within 5 Days.

52. Healing is complete after 3 to 6 weeks.

53. Cryotherapy in daily practice
For the first time cryotherapy is accurate to the millimeter.
No Collateral Damage = No pain.
The moment pain is experienced the freezing has reached the caudal extent of the lesion. At this moment the treatment will stop.
The operator can now evaluate the depth of treatment by feedback of the patient.

54. Superficial Verrucae on the foot.

55. Tissue shown immediately after freezing.

56. Aseptic Necrosis of the treated tissue shows within 5 Days.56

57. 10 to 12 days after the treatment the scab will disintegrate.

58. Healing is complete after 3 to 6 weeks.

59. Angioma in male patient

60. Full recovery in 3 weeks

61. Seborrheic Keratosis in female patient

62. Full recovery in 3 weeks

63. Next generation Cryotherapy treatment with CryoPen

64. Excellence made affordable
CryoPen|c
Excellence made affordable
Utilizes Disposable 8g Cartridges
Comes with 1 Standard Micro-Applicator
Removing the End Cap will start the flow of Cryogen
Flow can be stopped by replacing the end cap

65. Accuracy at the touch of your finger
CryoPen|m
Accuracy at the touch of your finger
Full Control with on/off switch
Utilizes Disposable 8g Cartridges
Comes with 2 micro-applicators for ultimate accuracy and flexibility

66. CryoPen|x Extremely efficient extremely gas efficient
full control with on/off switch
ready for use with 8g and with 16g cartridges
reassuring refined design with aluminum housing
comes with 4 micro-applicators for ultimate accuracy and flexibility

67. 8g- und 16g cartridges Nothing more easy …
8g: 100 – 120 seconds gas flow
16g: 200 – 240 seconds gas flow
Filled with liquefied nitrous oxide
No refilling; dispose with metal waste
Blister peel-pack with cartridge and filter device

68. Accuracy to the millimeter
Micro-applicators
Accuracy to the millimeter
Blue dot applicator Applications of 1-3 mm
White dot applicator Applications of 2-5 mm
Green dot applicator Applications of 4-8 mm
Yellow dot applicator
Applications of 6-15 mm
enhanced design with extra filter built-in
various flow rates available for more treatment options
color coded for easy recognition
all come with protective cap

69. Cartridges Box has 24 8g cartridges with opener and filter
Freezing rate : Approx. 1 mm per 5 seconds

70. Treat Skin Lesions that you would not have treated before.
CryoPen
Solving today‘s challenges in Skin Lesion Treatment
Treat Skin Lesions that you would not have treated before.
Fast and efficient application
Without undesired side effects.
Great potential for the marketing of your Clinic.

72. CryoPen, more service for your patients
Thank you for your attention