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1Wouldnt it be nice to improve the quality of skin lesion treatment ?

12AgendaWart and Skin Lesion Treatment Modalities

What is Cryotherapy?

Traditional application of Cryotherapy

The innovation of CryoPen.

How to apply.

2Warts are most common on the hands, feet or genitals. They are caused by HPV-infections and are commonly known as Verrucae Vulgaris. Warts

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4Why 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 patients4Cosmetic lesionsRemoving cosmetic skin lesions is becoming increasingly common as we all aspire to be attractive and stay youthful as we age.

Wouldnt it be nice to improve your treatment modality for these lesions.

5Family Physicians in General PracticeMy Patients have no Warts.

I dont 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.

6How 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.

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7What are the alternatives ?8HF-surgery and laser

Disadvantages;

Pain Anaesthesia requiredRisk of collateral damage. Risk of depigmentation, mainly in darker skinScars easily.8Why Cryotherapy ?9Literature 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.910Definition of cryotherapyCryotherapy is the controlled destruction of unwanted tissue by the precise application of extreme cold.

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Plantar Wart1112First freeze 30 sec, same session second freeze 30 sec

Immediately after Treatment1213

Aseptic Necrosis of the treated tissue shows within 3 days.1314

7 to 10 days after the Treatment the scab will disintegrate.1415

Healing is complete after 3 to 6 weeks.1516

Wart on hand16

17Necrosis of the tissue within 7 Days.1718

The crust has disintegrated and the tissue will fully regenerate within the next few weeks.1819

Healing is complete after 3 to 6 weeks.1920The advantages of CryotherapySterile 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.

20Are these claims confirmed in daily practice?No blisters, no pain?

Always good results?

Will one or two treatments cure the lesion?

Definitive result?2122CryotherapyThe success/result of Cryotherapy Treatment will depend on the level of the users expertise.

What are the criteria for successful Treatment?

2223Intracellular fluidNucleusCell membraneExtracellular fluidCell structure23

Osmose: Principle of Cell Preservation At slow freezing rates cells are given time for self protection. Slow freezeFast thaw

Intracellular fluidNucleusCell MembraneExtracellular fluid24

Principle of Cell DestructionIntracellular fluid freezes, tiny spiked shards of ice areformed, cell membranes rupture, which will be the cause of Cell Destruction. Fast freeze Slow thaw

Intracellular fluidNucleusCell MembraneExtracellular fluid25Effective cryonecrosis from -27CIt is described extensively in literature that:

rapid freezing to minus (-) 27C and more will produce cryonecrosis in all human tissues.26Why 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. 2728Rapid freeze, slow unassisted thaw

Fast lowering of the temperature from +37C to -27C

TWO freezing cycles in ONE treatment session

Enough freezing power should be available to reach the bottom of the wart.Key criteria of cryonecrosis2829

Traditional Cryotherapy treatment

Application with a cotton bud soaked with Liquid Nitrogen292930

A hassle to store and to refill30No control of energy transmissionCotton buds will rapidly lose energy

31No control over temperatureNo control over energy

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No control over temperature

32No Control Over Penetration DepthIf 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.

34Cotton buds never fit well to the lesion resulting in inevitable inclusion of normal healthy tissue resulting in pain and blisters.

No control over the inclusion zone34Definition of Cryotherapy35Cryotherapy is the controlled destruction of unwanted tissue by the precise application of extreme cold.

35Indirect DirectThe 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.

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Cryotherapy with N2 sprayIn hospital settings, Dermatologists sometimes use LN pumps for direct application of Liquid Nitrogen onto the tissue3738

Better control over temperatureBetter 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

Cryotherapy with N2 spray38With 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.Analysis of the traditional methods and how they can be improved

393940Why pressure ?

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Pinpoint Precision at -89C, So easy to work with ...4142

Treat successfully skin lesions that you did not treat before.

Discover how this feature will create more Treatment Opportunities4243

Even the smallest lesions can now be treated without collateral damage4344

Wart in Eyebrow44

45Tissue Necrosis after 5 days45

Total Recovery after 3 weeks46

47The innovation of CryoPenPinpoint 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!

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Practical/Technical AspectsFreezing Rate: 1 mm per 5 seconds.

Maximum penetration: From 4 to 7 mmDepending on the volumetric flow rate by the choice of the relevant CryoPen Applicator

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Wart on the face.5051

Necrosis of tissue within 5 Days.5152

Healing is complete after 3 to 6 weeks.52Cryotherapy in daily practiceFor 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.

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Superficial Verrucae on the foot.5455

Tissue shown immediately after freezing.5556

Aseptic Necrosis of the treated tissue shows within 5 Days.565657

10 to 12 days after the treatment the scab will disintegrate.5758

Healing is complete after 3 to 6 weeks.58

59Angioma in male patient5960

Full recovery in 3 weeks60

61Seborrheic Keratosis in female patient61

62Full recovery in 3 weeks6263Next generation Cryotherapy treatmentwith CryoPen

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CryoPen|cExcellence made affordable

Utilizes Disposable 8g CartridgesComes with 1 Standard Micro-ApplicatorRemoving the End Cap will start the flow of CryogenFlow can be stopped by replacing the end cap

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65CryoPen|m Accuracy at the touch of your fingerFull Control with on/off switchUtilizes Disposable 8g CartridgesComes with 2 micro-applicators for ultimate accuracy and flexibility 65

66extremely gas efficientfull control with on/off switchready for use with 8g and with 16g cartridgesreassuring refined design with aluminum housingcomes with 4 micro-applicators for ultimate accuracy and flexibility

CryoPen|x Extremely efficient

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8g- und 16g cartridgesNothing more easy 8g: 100 120 seconds gas flow16g: 200 240 seconds gas flowFilled with liquefied nitrous oxideNo refilling; dispose with metal wasteBlister peel-pack with cartridge and filter deviceenhanced design with extra filter built-invarious flow rates available for more treatment optionscolor coded for easy recognitionall come with protective capMicro-applicatorsAccuracy to the millimeter

Blue dot applicator Applications of 1-3 mmWhite dot applicator Applications of 2-5 mmGreen dot applicator Applications of 4-8 mmYellow dot applicatorApplications of 6-15 mm68

Cartridges69Box has 24 8g cartridges with opener and filter Box has 6 16g cartridges with opener and filter

Freezing rate : Approx. 1 mm per 5 seconds 69CryoPenSolving todays 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. 71

71CryoPen, more service for your patients

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Thank you for your attention72