Warts are caused by human papillomavirus (HPV) infection and can involve multiple parts of skin and mucosa, of which periungual and subungual warts are the most difficult to treat. Periungual or subungual wart is verruca vulgaris growing around or under the fingernail, destroying and deforming the nail and nail bed. Currently, liquid nitrogen cryotherapy and CO2 laser are often used for the treatment. Clinically, few doctors routinely use photodynamic therapy (PDT) to treat viral warts. We used PDT combined with liquid nitrogen cryotherapy and curettage to successfully treat a case of intractable periungual and subungual warts.

OBJECTIVE: To evaluate the clinical efficacy and safety of 595-nm pulsed dye laser in the treatment of verruca vulgaris in children and to compare the efficacy of this method against two other methods, microwave tissue coagulation and liquid nitrogen cryotherapy.
METHODS: A total of 90 children being treated in the dermatology outpatient department of our hospital from 2019 to 2021 were selected and divided into three groups: the treatment group A (n = 30, treated with a 595-nm pulsed dye laser), treatment group B (n = 30, treated with microwave tissue coagulation), and treatment group C (n = 30, treated with liquid nitrogen cryotherapy). All the patients in the treatment group A, treatment group B, and treatment group C were treated once every two weeks, with a maximum of six treatments.
RESULTS: The response rate of the treatment group A was 93.3%, which was higher than the 83.3% rate of treatment group B and the 66.7% rate of treatment group C. The average treatment times of the treatment group A (2.45 ± 1.10) were lower than group B (3.51 ± 0.98) and group C (4.63 ± 0.96). The adverse reaction rate in the treatment group A (16.7%) was significantly lower than that in treatment group B (56.7%) and treatment group C (63.3%). The differences were statistically significant (all p < 0.05).
CONCLUSIONS: The 595-nm pulsed dye laser is safe and seems to be the most effective treatment for verruca vulgaris in children. Further high-level clinical trial is warranted to verify our results.

Alopecia areata (AA) is an autoimmune disease that is represented as patches of hair loss, fractional CO2 laser and cryotherapy are used to stimulate hair growth in patients of AA. Evaluation of fractional CO2 laser effect versus liquid nitrogen cryotherapy in the treatment of AA. Eighty patients presented with patches of AA. The first group consisted of 40 patients were treated with fractional CO2 laser, the second group also 40 patients were treated with cryotherapy. The efficacy of the treatment was statistically evaluated. A positive therapeutic response was noted in most patients by trichoscopy at the end of treatment, there was a decrease in exclamation mark hairs, yellow dots, black dots, broken hairs, and an increase in short vellus hair and circle hair of patients compared to baseline and control. No serious side effects were seen. Fractional CO2 laser and liquid nitrogen cryotherapy are considered a promising, safe, and effective treatment modality with the better result with CO2 laser.

BACKGROUND: Lichen simplex chronicus (LSC) is characterized by localized lichenification and intense itching. It has been reported that the added use of liquid nitrogen cryotherapy (LNC) for LSC has significant efficacy and notable safety. Therefore, we conducted a meta-analysis based on existing randomized controlled trials (RCTs).
METHODS: We searched RCTs on LNC for LSC published up to August 2020 using various databases, including PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang Database. Other studies were manually identified using the references cited in reviews. We applied fixed- or random-effects models, and all analyses were performed using Review Manager 5.4 software.
RESULTS: Twelve RCTs involving 1,066 participants provided eligible data for the meta-analysis. Based on the clinical effective rate, LNC treatment of LSC (risk ratio, RR 1.25, p = 0.005, I2 = 82%) was superior to controls. Subgroup analysis showed that the use of LNC alone (RR 1.04, I2 = 95%, p > 0.05) is not more effective than other therapies in the treatment of LSC, but the addition of LNC to the existing treatment increases the total clinical efficacy. Furthermore, the combined effect of LNC and topical medication (RR 1.39, I2 = 0%, p < 0.0001) was better than that of LNC and oral medication (RR 1.30, I2 = 0%, p < 0.00001). Greater frequency of LNC treatment did not improve the efficacy (thrice a week: RR 1.39 [1.21, 1.60]; twice a week: RR 1.27; once every 2 weeks: RR 1.32). Data from 6 RCTs with 508 participants showed no significant difference in AEs (p = 0.31) associated with added LNC treatment.
CONCLUSIONS: The addition of LNC (applying a cotton swab soaked with liquid nitrogen to wipe the lesion for approximately 10 s each time) to topical ointments, is effective and safe in the treatment of LSC. Increasing the treatment frequency of LNC did not necessarily improve the efficacy.

OBJECTIVE: To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris.
METHODS: A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group (300 cases, 2 cases dropped off), a fire needling group (300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group (300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte (CD+3、CD+4、CD+8、CD+4/ CD+8) in peripheral blood were observed before and after treatment, and the adverse reaction was recorded in the 3 groups. Five weeks after treatment, the therapeutic effect was evaluated.
RESULTS: Compared before treatment, the skin lesion scores were decreased (P<0.05), the levels of T lymphocyte in peripheral blood were increased in the 3 groups (P<0.05). After treatment, all the items of the skin lesion score in the fire needling stripping group were lower than those in the fire needling group and the liquid nitrogen cryotherapy group (P<0.05), the levels of T lymphocyte in peripheral blood were higher than those in the fire needling group and the liquid nitrogen cryotherapy group (P<0.05); all the items of the skin lesion score in the liquid nitrogen cryotherapy group were lower than those in the fire needling group (P<0.05). At the follow-up, the total effective rate was 88.6% (264/298) in the fire needling stripping group, which was superior to 81.4% (241/296) in the fire needling group and 81.4% (240/295) in the liquid nitrogen cryotherapy group (P<0.05). The cases of infection, causalgia and cicatrix in the liquid nitrogen cryotherapy group were more than those in the fire needling stripping group and the fire needling group (P<0.05).
CONCLUSIONS: Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.
目的：比较贴麻后火针剥除术、单纯火针与液氮冷冻治疗寻常疣的临床疗效。方法：将900例寻常疣患者随机分为火针剥除术组（300例，脱落2例）、火针组（300例，脱落4例）和液氮冷冻组（300例，脱落5例）。火针剥除术组采用复方利多卡因乳膏贴麻处理后行火针治疗，并剥除疣体坏死组织；火针组仅行火针治疗，不行贴麻及剥除术；液氮冷冻组采用液氮冷冻法治疗，3组均每周治疗1次，共治疗3周。观察3组患者治疗前后皮损（数目、大小、厚度、颜色、瘙痒、同形反应）评分及外周血T淋巴细胞（CD+3、CD+4、CD+8、CD+4/ CD+8）水平，记录3组试验过程中的不良反应，并于治疗后5周随访时评定临床疗效。结果：与治疗前比较，3组患者治疗后各项皮损评分均降低（Ｐ<0.05），外周血T淋巴细胞水平均上升（P<0.05）。治疗后火针剥除术组各项皮损评分均低于火针组及液氮冷冻组（P<0.05），T淋巴细胞水平均高于火针组及液氮冷冻组（P<0.05）；液氮冷冻组各项皮损评分均低于火针组（P<0.05）。随访时火针剥除术组总有效率为88.6%（264/298），高于火针组的81.4%（241/296）及液氮冷冻组的81.4%（240/295，P<0.05）。液氮冷冻组感染、灼痛及瘢痕不良反应发生例数高于火针剥除术组及火针组（P<0.05）。结论：贴麻后火针剥除术可有效治疗寻常疣，改善患者皮损情况及免疫功能，其疗效优于单纯火针及液氮冷冻。.

OBJECTIVE: To evaluate the efficacy and safety of liquid nitrogen cryotherapy as a primary or rescue treatment for BE, with and without dysplasia, or intramucosal adenocarcinoma (IMC).
METHODS: This was a retrospective, single-center study carried out in a tertiary care center including 45 patients with BE who was treatment-naïve or who had persistent intestinal metaplasia (IM), dysplasia, or IMC despite prior therapy. Barrett\'s mucosa was resected via EMR when clinically appropriate, then patients underwent cryotherapy until eradication or until deemed to have failed treatment. Surveillance biopsies were taken at standard intervals.
RESULTS: From 2010 through 2014, 33 patients were studied regarding the efficacy of cryotherapy. Overall, 29 patients (88%) responded to cryotherapy, with 84% having complete regression of all dysplasia and cancer. Complete eradication of cancer and dysplasia was seen in 75% of subjects with IMC; the remaining two subjects did not respond to cryotherapy. Following cryotherapy, 15 patients with high-grade dysplasia (HGD) had 30% complete regression, 50% IM, and 7% low-grade dysplasia (LGD); one subject had persistent HGD. Complete eradication of dysplasia occurred in all 5 patients with LGD. In 5 patients with IM, complete regression occurred in 4, and IM persisted in one. In 136 cryotherapy sessions amongst 45 patients, adverse events included chest pain (1%), stricture (4%), and one gastrointestinal bleed in a patient on dual antiplatelet therapy who had previously undergone EMR.
CONCLUSIONS: Cryotherapy is an efficacious and safe treatment modality for Barrett\'s esophagus with and without dysplasia or intramucosal adenocarcinoma.

BACKGROUND: Liquid nitrogen cryotherapy is a commonly used technique to treat a wide variety of dermatologic conditions including actinic keratoses, non-melanoma skin cancers, verrucae, and seborrheic keratoses. The risks associated with liquid nitrogen cryotherapy are important to know and discuss with patients prior to treatment.
OBJECTIVE: We report a case of cellulitis secondary to liquid nitrogen cryotherapy for actinic keratosis. We sought to review the literature for an estimate of secondary infection rates following cryotherapy treatment.
METHODS: We searched Pubmed using the terms cryotherapy and infection or cellulitis. We then looked at articles classified as clinical trials where cryotherapy was used to treat skin conditions. We then selected clinical trials that listed cellulitis or infection as an adverse event.
CONCLUSIONS: There were no case reports, case series, or review articles detailing the risk of infection from liquid nitrogen cryotherapy. We found 8 articles classified as clinical trials on Pubmed that did list infection as an adverse event. The risk of infection from these studies varied from approximately 2% to 30%. There was a great degree of heterogeneity in treatment sites, length of treatment, and treatment targets. While it is difficult to determine the true incidence of infection from liquid nitrogen cryotherapy, clinicians should endeavor to inform patients of this potential risk.