Definition and Overview

Paediatric cryotherapy is a procedure that gets rid of warts on young patients. This procedure is beneficial for children of all ages as well as adolescents and teenagers who get warts that cause certain symptoms and do not respond to other forms of treatment.

Warts tend to be common among young children two years of age and older because their immune systems are not yet fully developed. Getting treatment is crucial because warts are contagious and can easily spread as kids play and interact with one another. Warts are caused by viral infections affecting the surface of the skin on the hands, fingers, feet, toes, soles of the feet and the knees.

Although most childhood warts resolve on their own even without treatment, children may find them painful or uncomfortable, especially when they grow in size. In such cases, paediatric freezing of warts (cryotherapy) may be recommended by their paediatrician.

Who Should Undergo and Expected Results

Cryotherapy is one of the treatment options that can be used to remove warts in pediatric patients, which include all children as well as adolescents and teenagers. The procedure can remove different types of warts, including:

  • Common warts – These are small, hard, dome-shaped bumps that range in color from gray to brown. They most commonly grow on the fingers, hands, knees and elbows. They sometimes form in clusters, resembling a cauliflower in the process, and may also have black dots in the middle.

  • Plantar warts – These are most commonly found on the bottom of the foot and can thus be very uncomfortable.

  • Flat warts – These are smoother-looking warts that are flat on top. Also called juvenile warts, they can grow in any part of the body and usually occur in groups.

  • Filiform warts – These are flesh-colored bumps that commonly grow around the mouth, eyes and nose area.

  • Genital warts – These are linked to the HPV virus or cervical problems. Thus, the presence of these warts may lead doctors to suspect problems with the cervix, and this can, in turn, lead to a Pap smear and other diagnostic tests to rule out or identify an underlying disease that caused warts to occur.

Although warts are benign, these skin eruptions can cause itching and discomfort, and many parents may be additionally concerned about the physical appearance of the hard and rough bumps on their children’s skin. Also, warts can grow in a sensitive area, such as the groin, the rectum, or the genitals. In these cases, the patient may benefit greatly from wart freezing.

However, cryotherapy is not the primary treatment prescribed for children with warts. The most common treatment method is the application of salicylic acid or other over-the-counter or prescription ointments. This is a non-invasive treatment where an ointment is simply applied to the wart until it disappears. This may take some time, though, so if the patient prefers faster results, cryotherapy may be considered. Also, there are some cases wherein warts do not go away even with the continuous application of salicylic acid. Other treatment options, aside from freezing the warts, include:

  • Burning the wart off
  • Laser wart removal
  • Surgical excision
  • Using home remedies, such as the well-known “duct tape technique”, although these are not guaranteed to work as well as cryotherapy and may not keep warts from coming back

Of these three options, freezing the wart is the safest and less painful option, making it more appropriate for paediatric patients.

The freezing of pediatric warts is very effective and works in more than 50% of cases. However, it requires up to four treatment sessions.

How the Procedure Works?

Cryotherapy can remove most warts within four sessions, with each session scheduled one to three weeks apart and performed in a doctor’s clinic or office. This treatment works by freezing the warts so they can be easily removed.

Each treatment involves several steps:

  • Trimming the warts using a small knife.
  • Application of liquid nitrogen – This step takes only a minute. The liquid nitrogen can be applied by spray or with the use of a cotton swab.

After a wart has been removed by freezing it, it is normal for a blister to form on the affected area but will eventually break within a few days. If this happens, it is important to clean the affected area to keep the virus from spreading and causing another wart. The blister will slowly dry, which may take a few days until the wart finally falls off by itself.

Before undergoing cryotherapy, patients and their guardians should be made aware that the procedure can cause some pain and discomfort. The pain is mild to moderate, but may be more severe if the wart is on an area that has thin, sensitive skin. Fortunately, the pain only lasts for a short while and is generally tolerable especially for older patients. However, this may be a concern for younger patients. Thus, it is best to discuss the risks and benefits of the treatment with a paediatric dermatologist before the procedure is performed.

It is also important for parents to know that childhood warts are unlikely to cause lasting problems or health repercussions, so they may choose to forego treatment completely and just observe the warts to check for changes.

Possible Risks and Complications

Cryotherapy is very safe even for paediatric patients. Among all existing treatment options for pediatric warts, this technique is the less likely to cause long-term damage to the skin surface.

However, all medical procedures are associated with certain risks, and paediatric cryotherapy is no different. It may lead to:

  • Scarring
  • Pain
  • Swelling
  • Heat or warmth feeling in the treated area
  • Redness
  • Tenderness
  • Red streaks around the affected area
  • Pus discharge
  • Fever

However, if the procedure is done carefully, these risks and possible complications can be easily prevented. Also, seeking treatment early can help minimize the potential risks of the procedure. This is because having warts removed when they are relatively new is easier because they will be thinner and will thus fall off more easily. If treatment is delayed, the warts may become thicker as time passes. The bigger the warts, the more sessions are needed, and the higher the risk of nerve damage, which can eventually lead to scarring.


  • Habif TP. Dermatologic surgical procedures. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2009:chap 27.

  • Habif TP. Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2009:chap 12.

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