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Wouldn’t it be nice to improve the quality of skin lesion treatment ?

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Agenda

● Wart and Skin Lesion Treatment Modalities

● What is Cryotherapy?

● Traditional application of Cryotherapy

● The innovation of CryoPen.

● How to apply.

Warts 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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Why should warts be treated quickly ?

1. When small, a wart is more easily removed.

2. When removed, a wart will no longer be the origin of further spread.

Prevention and service to patients…

Cosmetic lesions

Removing cosmetic skin lesions is becoming increasingly common as we all aspire to be attractive and stay youthful as we age.

Wouldn’t it be nice to improve your treatment modality for these lesions.

Family Physicians in General Practice

●My Patients have no Warts.

●I don’t 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.

How 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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What are the alternatives ?

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HF-surgery and laser

Disadvantages;

• Pain – Anaesthesia required

• Risk of collateral damage.

• Risk of depigmentation, mainly in darker skin

• Scars easily.

Why Cryotherapy ?

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Literature 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.

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Definition of cryotherapy

“Cryotherapy is the controlled destruction of unwanted tissue by

the precise application of extreme cold.”

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Plantar Wart

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First freeze 30 sec, same session second freeze 30 sec

Immediately after Treatment

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Aseptic Necrosis of the treated tissue shows within 3 days.

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

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Healing is complete after 3 to 6 weeks.

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Wart on hand

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Necrosis of the tissue within 7 Days.

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

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Healing is complete after 3 to 6 weeks.

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The advantages of Cryotherapy

● Sterile 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.

Are these claims confirmed in daily practice?

●No blisters, no pain?

●Always good results?

●Will one or two treatments cure the lesion?

●Definitive result?

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Cryotherapy

The success/result of Cryotherapy Treatment will depend on the level of the user’s expertise.

What are the criteria for successful Treatment?

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Intracellular fluid

Nucleus

Cell membrane

Extracellular fluid

Cell structure

Osmose: Principle of Cell Preservation

At slow freezing rates cells are given time for self protection.

Slow freezeFast thaw

Intracellular fluid

Nucleus

Cell Membrane

Extracellular fluid

Principle of Cell Destruction

Intracellular fluid freezes, tiny spiked shards of ice areformed, cell membranes rupture, which will be the cause of Cell Destruction.

Fast freeze Slow thaw

Intracellular fluid

Nucleus

Cell Membrane

Extracellular fluid

Effective cryonecrosis from -27°C

It is described extensively in literature that:

“rapid freezing to minus (-) 27°C and more will produce cryonecrosis in

all human tissues”.

Why 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.

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• Rapid freeze, slow unassisted thaw

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

• TWO freezing cycles in ONE treatment session

• Enough freezing power should be available to reach the bottom of the wart.

Key criteria of cryonecrosis

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Traditional Cryotherapy treatment

Application with a cotton bud soaked with Liquid Nitrogen

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A hassle to store and to refill

No control of energy transmission

Cotton buds will rapidly lose energy

No control over temperature

No control over energy

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No control over temperature

No Control Over Penetration Depth

If 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.

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Cotton 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 zone

Definition of Cryotherapy

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Cryotherapy is the controlled destruction of unwanted tissue by the precise application of

extreme cold.

Indirect Direct

The 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 spray

In hospital settings, Dermatologists sometimes use LN pumps for direct application of Liquid Nitrogen onto the tissue

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• Better control over temperature• Better 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 spray

With 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

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Why pressure ?

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

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Discover how this feature will create more Treatment Opportunities

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Even the smallest lesions can now be treated without collateral damage

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Wart in Eyebrow

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Tissue Necrosis after 5 days

Total Recovery after 3 weeks

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The innovation of CryoPen

Pinpoint 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 Aspects

Freezing 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.

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Necrosis of tissue within 5 Days.

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Healing is complete after 3 to 6 weeks.

Cryotherapy in daily practice

For 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.

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Tissue shown immediately after freezing.

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Aseptic Necrosis of the treated tissue shows within 5 Days.

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

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Healing is complete after 3 to 6 weeks.

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Angioma in male patient

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Full recovery in 3 weeks

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Seborrheic Keratosis in female patient

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Full recovery in 3 weeks

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Next generation Cryotherapy treatmentwith CryoPen

CryoPen|cExcellence made affordable

Utilizes Disposable 8g CartridgesComes with 1 Standard Micro-Applicator

Removing the End Cap will start the flow of CryogenFlow can be stopped by replacing the end cap

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CryoPen|m Accuracy at the touch of your finger

Full Control with on/off switchUtilizes Disposable 8g Cartridges

Comes with 2 micro-applicators for ultimate accuracy and flexibility

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extremely gas efficient full control with on/off switch

ready for use with 8g and with 16g cartridges reassuring refined design with aluminum housing

comes with 4 micro-applicators for ultimate accuracy and flexibility

CryoPen|x Extremely efficient

8g- und 16g cartridgesNothing more easy  …

8g: 100 – 120 seconds gas flow16g: 200 – 240 seconds gas flowFilled with liquefied nitrous oxide

No refilling; dispose with metal wasteBlister peel-pack with cartridge and filter device

●enhanced design with extra filter built-in

●various flow rates available for more treatment options

●color coded for easy recognition

●all come with protective cap

Micro-applicatorsAccuracy to the millimeter

Blue dot applicator Applications of 1-3 mm

White dot applicator Applications of 2-5 mm

Green dot applicator Applications of 4-8 mm

Yellow dot applicatorApplications of 6-15 mm

Cartridges

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Box 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

CryoPenSolving today‘s 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.

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CryoPen, more service for your patients

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Thank you for your attention