Applying ultrasound gel to a viral wart before cryotherapy can increase the freezing time, improve the rate of treatment efficacy, and reduce the adverse events associated with cryotherapy, study research in the Journal of the American Academy of Dermatology suggests.

Viral warts, commonly caused by the human papillomavirus, present with various treatment challenges. Although viral warts can spontaneously resolve, many require treatment for complete removal. These types of warts may become resistant to standard therapy and have a higher rate of recurrence. Treatments for viral warts include topical salicylic acid, glutaraldehyde, duct tape occlusion, topical 5-fluorouracil, retinoic acid, and vitamin D analogues.

A targeted treatment approach, such as cryotherapy, destroys diseased tissue via the application of cold temperatures. Rapid heat transfer from the tissue causes injury, vascular stasis, inflammation, and occlusion, ultimately leading to the destruction of tissue. The formation of intracellular ice also results in damage to the organelles. The severe vasoconstriction and endothelial damage caused by the cold temperatures typically result in platelet aggregation and microthrombi formation, leading to ischemic necrosis.

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To prolong the freeze time of cryotherapy, the researchers recommend application of ultrasound gel to the wart before intervention. According to the authors, this can prolong temperature and freeze time and make the operation more effective. In addition, the use of ultrasound gel can help minimize the use of cryogen, which may further improve safety outcomes.

“Use of ultrasound gel followed by cryotherapy increases the freezing time with minimal use of cryogen,” the researchers wrote, “thereby increasing the success rate with minimal side effects of cryotherapy.”

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Reference

Vedamurthy M, S R S, Vanasekar P. SURGICAL PEARL: use of ultrasound gel to increase efficacy of cryotherapy in treatment of warts [published online February 25, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.02.054