(3) Treatment: cryosurgery. This is treatment by liquid nitrogen and is
performed in this manner:
(a) Prepare a large cotton-tipped swab by winding the tip to a point.
(b) Dip the applicator into nitrogen.
Immediately apply the tip to the center of the lesion.
(d) A white hard freeze will rapidly propagate in all directions.
(e) During the freezing process, the patient will experience pain that
ranges from moderate to intense.
(f) Remove the swab after a 1 mm rim of freeze surrounding the lesion
has been established.
It is better to under treat a benign lesion than to freeze too vigorously and
destroy excessive amounts of normal tissue.
DO NOT use liquid nitrogen on a patient's palms, soles, or areas that are
automatically confined, such as the area around the nails. Swelling will
occur in these confined areas.
b. Plantar Warts.
(1) Description. A plantar wart is a wart that occurs on the sole of the foot.
Plantar warts occur at maximum pressure points; for example, over the heads of the
metatarsal bones and on the heels. These warts are thick, painful calluses which have
formed in response to pressure.
(2) Treatment: general. Treatment is not required as long as the warts are
painless. It may be better not to subject the patient to a course of treatment but to let
the wart go through the normal evolution. Severely painful plantar warts may be treated
by keratolytic therapy (duofilm) or blunt dissection.
(3) Keratolytic therapy (duofilm). This type of treatment is conservative
initial therapy. The treatment is nonscarring and relatively effective. It does require
(a) Pare down the wart with pumice stone or sandpaper.
(b) Soak the area in warm water to aid in the absorption of the