Cryotherapy in Dermatology: Treating Warts and Other Skin Lesions with Liquid Nitrogen
By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia
Cryotherapy is a commonly used dermatological procedure that treats selected skin lesions through controlled freezing. It is usually performed in an outpatient clinic and often avoids the need for surgical excision or stitches.
Liquid nitrogen cryotherapy can be used for viral warts, certain benign skin growths, and selected precancerous lesions. Although treatment usually takes only a few minutes, an accurate diagnosis, appropriate technique, and good aftercare are essential.
This article explains how cryotherapy works, which conditions it can treat, and what patients can expect during recovery.
What Is Cryotherapy?
Cryotherapy, also called cryosurgery, destroys targeted tissue by exposing it to extremely low temperatures.
In dermatology, the most commonly used freezing agent is liquid nitrogen, which has a temperature of approximately −196°C. Controlled freezing damages the cells within the lesion. As the area heals, the treated tissue may peel away or form a crust that gradually separates.
The depth and duration of freezing are adjusted according to the diagnosis, thickness of the lesion, and treatment site.
Which Skin Conditions Can Be Treated?
Viral Warts
Viral warts are caused by the human papillomavirus (HPV) and are among the most common reasons for cryotherapy.
They include common warts on the hands and fingers, plantar warts on the soles, and periungual warts around the nails. Cryotherapy may also be considered for selected flat warts, although extra caution is needed on the face because of the risk of pigment changes.
Warts often require several treatment sessions. Thick plantar warts can be particularly persistent, and carefully removing excess surface skin before freezing may help treatment reach the wart.
Treatment around the nails requires care because damage to the nail matrix—the area responsible for nail growth—can cause lasting nail changes.
Seborrhoeic Keratoses
Seborrhoeic keratoses are benign growths that often have a waxy or “stuck-on” appearance. They become more common with age and may be brown, black, or skin-coloured.
Treatment may be considered when they become irritated, itchy, or cosmetically bothersome. Cryotherapy is generally more suitable for thinner lesions; thicker growths may respond better to another procedure.
A lesion with unusual pigmentation or an uncertain diagnosis should be assessed before removal.
Skin Tags
Skin tags are small, soft, benign growths commonly found on the neck, armpits, and skin folds.
Cryotherapy is one option for selected skin tags. Depending on their size and location, snip excision or electrosurgery may offer a more suitable approach.
Actinic Keratoses
Actinic keratoses are rough, scaly lesions caused by cumulative sun exposure. They are considered precancerous because some can progress to squamous cell carcinoma.
Cryotherapy can treat selected individual lesions. When there are numerous actinic keratoses or widespread sun damage, treatment of the wider affected area may be more appropriate.
A lesion that is thickened, tender, rapidly growing, or otherwise suspicious may require biopsy before treatment.
Other Selected Conditions
Cryotherapy may also be used for molluscum contagiosum in selected patients. In specialist practice, it can occasionally treat carefully selected, biopsy-confirmed superficial skin cancers. Suitability depends on the diagnosis, location, and risk of recurrence.
How Is Cryotherapy Performed?
The dermatologist first examines the lesion and determines whether freezing is appropriate. Dermoscopy or a biopsy may be needed if the diagnosis is uncertain.
Liquid nitrogen is then applied using a spray device, a cotton-tipped applicator, or a cryoprobe. The skin briefly turns white as it freezes, then thaws. Some lesions require more than one freeze–thaw cycle.
Each application generally lasts seconds, and the overall procedure is usually completed within a few minutes. The treatment intensity is tailored to the lesion and nearby structures.
Is Cryotherapy Painful?
Patients commonly feel a cold, stinging, or burning sensation during treatment. Soreness or throbbing may continue afterwards, particularly on the fingertips, around the nails, or on the soles.
Local anaesthesia is not routinely required for simple cryotherapy. However, comfort and treatment suitability should be considered individually, especially in children.
What Happens After Treatment?
The treated area may develop redness, swelling, tenderness, or a clear or blood-filled blister. A crust may form as the skin heals.
Blistering is a possible treatment response, but it is not required for cryotherapy to work. Its presence or absence does not reliably indicate whether the lesion has cleared.
Healing time varies with the site and depth of treatment. Small superficial areas may heal within one to two weeks, while deeper treatment sites and lesions on the lower legs can take considerably longer.
Seek medical advice if there is increasing pain, spreading redness, pus, fever, or difficulty using the affected hand or foot.
Caring for the Skin After Cryotherapy
Follow the instructions provided by your treating clinician. General aftercare includes:
Gently wash the area with water and a mild cleanser, then pat dry.
Avoid scratching, picking, or pulling off the crust.
Apply a thin layer of plain petroleum jelly if advised.
Use a non-adherent dressing if the area is open or exposed to friction.
Leave blisters intact unless your clinician advises otherwise.
Protect healing skin from sun exposure.
A large or painful blister may need assessment and, occasionally, drainage by a healthcare professional. Antibiotics are not routinely necessary after uncomplicated treatment.
Possible Side Effects and Risks
Cryotherapy can cause temporary pain, swelling, blistering, and crusting. Other possible effects include:
Lighter or darker skin marks, which may persist; loss of pigment can sometimes be permanent.
Scarring, particularly after deeper freezing.
Infection.
Temporary numbness or, rarely, lasting nerve damage.
Nail changes when treatment affects the nail matrix.
Incomplete clearance or recurrence.
Pigment changes deserve particular consideration in darker skin tones and when treating visible areas such as the face.
How Many Sessions Are Needed?
Some benign lesions respond to one session, while warts often need repeated treatment.
For suitable warts, sessions may be scheduled approximately two to four weeks apart, depending on healing, response, and tolerability. Persistent lesions should be reassessed rather than repeatedly frozen without reviewing the diagnosis and treatment plan.
Plantar warts can be difficult to clear because of the thick skin and pressure on the soles. Other approaches, such as topical salicylic acid, may be used alone or alongside cryotherapy when appropriate.
No treatment guarantees permanent clearance, and warts can recur.
Is Cryotherapy Suitable for Everyone?
Cryotherapy requires particular caution in people with poor circulation, reduced skin sensation, impaired wound healing, or conditions triggered by cold, such as cold urticaria or cryoglobulinaemia.
The location also matters. Lesions near superficial nerves, nail structures, or other sensitive areas may require a different approach.
Suspicious or undiagnosed lesions should be assessed before freezing. Cryotherapy destroys tissue and does not provide a specimen for laboratory examination. If melanoma or another skin cancer is suspected, appropriate diagnostic assessment and biopsy should take priority.
Choosing the Most Appropriate Treatment
Cryotherapy is one of several options for treating skin lesions. Alternatives include topical medication, curettage, electrosurgery, and surgical excision.
The best choice depends on the diagnosis, lesion size and location, previous treatment response, healing risks, cosmetic considerations, and patient preferences.
A quick procedure is useful only when it is appropriate for the condition being treated.
Cryotherapy at Dr Lim Skin Specialist Clinic
At Dr Lim Skin Specialist Clinic, Pantai Hospital Batu Pahat, Johor, patients with warts and other skin lesions can undergo dermatological assessment to determine whether cryotherapy or another treatment is suitable.
My priority is to establish an accurate diagnosis, explain the available options, and help patients understand the expected recovery and possible risks.
Cryotherapy remains a valuable treatment in everyday dermatology. With careful selection and appropriate aftercare, it can help manage a range of skin lesions while supporting safe healing.
This article provides general educational information. Treatment suitability and recovery vary according to the individual condition and clinical assessment.