INTRODUCTION

Cryotherapy, or cold therapy, is a non-invasive technique that uses cryogenic agents, such as liquid nitrogen, to freeze tissues at extremely low temperatures, leading to the destruction of targeted cells. Liquid nitrogen cryotherapy is a widely adopted therapeutic option in dermatology for the management of various skin conditions, including precancerous lesions, warts, actinic keratoses, molluscum contagiosum, and other dermatological disorders [1,2]. This method offers several advantages, notably the simplicity and speed of the procedure, the absence of mandatory local anesthesia, minimal side effects, low cost, and good patient tolerance [2].

In France, in 2018, 53% of actinic keratosis cases were managed solely by physical treatment—predominantly cryotherapy [3]. Similarly, a survey conducted by the American Society for Dermatologic Surgery and published in 1990 indicated that 87% of participating dermatologists regularly used cryotherapy in their practice [4]. In the United States, Damstra and Van Vloten [5] reported a 92% cure rate among 58 patients with condyloma acuminatum after three months of cryotherapy, while Kuflik [6,7] documented a 97.4% cure rate in eighty patients treated for common warts.

Although cryotherapy has become increasingly popular worldwide due to its effectiveness and ease of use, there remains a significant paucity of studies focusing on its long-term outcomes, especially in resource-limited settings such as those found in Africa. Moreover, data on the specific indications, protocols, patient experiences, and recurrence rates within African populations is scarce.

MATERIALS AND METHODS

RESULTS

From January 2021 to December 2023, out of 43,380 patients seen in consultation, we collected 676 patient records, among which 124 were persons with albinism, representing a hospital frequency of 1.6%.

Sociodemographic Data of Patients Without Albinism

During the study period, we observed a progressive increase in the number of patients treated with liquid nitrogen, rising from 150 to 234 (Table 1). Children and students accounted for 65.9% of the patients seen. Male patients accounted for 54.7%, which gives a sex ratio of 1.3.

Table 1: Distribution of the sample according to year of consultation.

96.9% of the patients consulted directly at the Bamako Dermatology Hospital (Table 2).

Table 2: Distribution of the sample according to mode of admission.

During the study period, we observed a progressive increase in the number of patients treated with liquid nitrogen, rising from 150 to 234. The Dermatology Hospital of Bamako has liquid nitrogen containers (Figs. 1 and 2) for the management of certain dermatological conditions that specifically require this therapeutic approach.

	Figure 1: Image of a Cryo Spray, self-pressurized container for liquid nitrogen storage (photo taken at HDB).
	Figure 2: The liquid nitrogen containers.

Clinical Data of Patients

The main conditions that motivated cryotherapy were molluscum contagiosum (46%) and HPV infections, including cutaneous warts (14.5%), Heck’s disease (10.9%), and condyloma (7.1%) (Table 3).

Table 3: Distribution of the sample according to etiology.

Among our cases, two sessions of liquid nitrogen application were reported in 29.7% of the patients (Table 4).

Table 4: Distribution of the sample according to the number of sessions.

DISCUSSION

We conducted a retrospective study on the epidemiological and clinical profile of patients treated with cryotherapy from January 2021 to December 2023 at the Bamako Dermatology Hospital, aiming to evaluate the effectiveness of cryotherapy in managing dermatoses. A total of 676 patients were selected for the study out of 43,380 patients seen in consultation, representing a hospital frequency of 1.6%. Persons with albinism accounted for 124 cases, representing 18% of the sample. The majority of the patients were male (54.7%), with a mean age of 15.23 years. The year 2023 had the highest patient volume, contributing 42.4% of the study sample. Over 93% of the sample came from the city of Bamako. Students and children were the most represented group. The majority of the patients were referred from consultation boxes within the hospital. Papular lesions were the most common elementary lesion. Molluscum contagiosum represented 46% of treated lesions, followed by HPV infections, including cutaneous warts (14.5%), Heck’s disease (10.9%), and condyloma (7.1%). The number of cryotherapy sessions was typically two (29.7% of cases), with two sessions for molluscum contagiosum and cutaneous warts, and six sessions for Heck’s disease and condyloma.

Persons with albinism were mainly treated for ephelides (96%), with an undetermined number of sessions in the majority of cases (38.7%). The study also highlighted a relationship between the type of dermatosis treated and the number of cryotherapy sessions, as well as the relationship between the type of dermatosis and the age of the treated patients.

Clinical Aspects

Mode of admission

In our study, almost all patients came on their own, representing 96.9% of the cases. This could be explained by the benign nature of most conditions treated with liquid nitrogen.

Sometimes, transfer cases are overlooked due to the absence of transfer forms.

Type of lesion

Papular lesions were the most common elementary lesions, accounting for 60.9% of the cases (Table 5), followed by verrucous keratotic lesions (24.1%) and keratotic lesions (13.8%). This clinical situation is consistent with the conditions encountered, including molluscum contagiosum and HPV infections.

Table 5: Distribution of the sample according to the type of lesion.

Lesion localization

All parts of the body were affected by lesions (Table 6). The most common locations were diffuse, facial, and acral areas. According to the literature, there is no absolute contraindication regarding the site for liquid nitrogen application. It is considered a good indication for the excision of certain tumors, such as those in the centrofacial area and at the tip of the nose [11,12].

Table 6: Distribution of the sample according to lesion topography.

Type of dermatosis

Cryotherapy is indicated for benign and premalignant lesions. In our series, the main indications were infectious lesions, such as molluscum contagiosum (46%), HPV infections, including cutaneous warts (14.5%), Heck’s disease (10.9%), and condyloma (7.1%) (Table 6). This result differs from Fraissenet M. [3] in France, where warts were the main indication for cryotherapy in 99.4% of cases.

The large difference may be explained by the patient recruitment method.

Calluses and Heck’s disease each represented 10%. The high demand for cryotherapy can be attributed to the accessibility of the product and ease of use.

However, our study did not include several pathologies such as leishmaniasis, Kaposi’s disease, and small cancerous lesions, which are also indications for cryotherapy. In 2017, Sehdev et al. in India reported that the effectiveness of cryotherapy is comparable to electrocoagulation in treating plantar warts, with a short healing time for cryotherapy [13]. In 2016, a meta-analysis showed that cryotherapy is effective in treating leishmaniasis, with similar efficacy to meglumine antimoniate [14]. For cancerous lesions, such as squamous cell carcinoma or basal cell carcinoma, small lesions under 2 cm are considered optimal indications for cryotherapy according to various authors [15].

CONCLUSION

This study has demonstrated the effectiveness and safety of cryotherapy in treating numerous benign dermatoses, such as molluscum contagiosum and HPV infections, including cutaneous warts, Heck’s disease, and condyloma. Molluscum contagiosum and cutaneous warts were cured after two sessions of application, while Heck’s disease and condyloma generally required six sessions for treatment. However, the lack of long-term follow-up for our patients and the absence of certain pathologies responsive to cryotherapy in our study should be considered for future research.

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