In the specialist practice of genital dermatology, treatment options like hyfrecation, laser therapy and cryotherapy are commonly used to remove skin lesions like genital warts, Fordyce spots, pearly penile papules (PPPs) and skin tags.
Now the question is, what is the difference between these treatments and which one is the right one for you? In practice, not many clinicians have detailed knowledge and understanding of all these treatment modalities, let alone practical experience and authority to make simple comparative remarks to assist the patients in making a correct choice.
Comparison By Method
Summary of Methods
Hyfrecation is very similar to laser in how it treats the lesions. The hyfrecator technology is powered by high frequency, low voltage electricity to destroy unwanted tissue in a controlled and precise way. This electrosurgical procedure is frequently used to remove skin lesions, such as warts, by destroying the affected tissue. Hyfrecation is a portmanteau of the words “high frequency eradicator.”
The main thing to keep in mind when understanding hyfrecation is that the tip of the treating probe remains at room temperature, however the heat is generated by tissue resistance to the passage of high frequency electricity. Furthermore, it is an extremely targeted procedure and thus does not affect or burn the surrounding normal tissue.
Laser therapy creates a microscopic column of light which burns and destroys the concerned tissue. Er:YAG laser (Erbium:yttrium-aluminium-garnet), CO2 laser and pulsed dye laser are variations of laser treatment.
The key difference between hyfrecation and laser is that hyfrecation uses electricity whilst laser uses light. However, similar to laser, hyfrecation treatment enables highly targeted treatment to only the areas of concern, reducing the risk of scarring or skin discoloration.
Lasers are excellent for high precision cuts, such as on the cornea or the brain, this is because the cut can be controlled on an incredibly small level. This also makes it great for skin work purposes.
However when it comes to treating the lesions in genital dermatology, we find that the versatility of hyfrecation results in better outcomes than laser (from specialist & patient experiences). We have patients who have been treated with laser elsewhere but come to us to finish the treatment using Hyfrecation.
Cryotherapy refers to treating the unwanted lesions by exposing them to super-cold liquid in a controlled way. The temperature of liquid should be colder than -50 degrees C. Liquid nitrous oxide (LNO2) or liquefied C02 are 2 commonly used agents for this purpose.
The cryogenic liquid is applied on a probe, disposable stick or can be sprayed onto the affected area directly and left for 10 to 20 seconds. It is then withdrawn after which the lesion goes back to normal. As the procedure can cause some discomfort, treatment is often done over a number of weeks.
With the passage of time, there will be gradual decrease in the volume and size of the lesions. Depending on how big and stubborn the lesions are, treatment will be repeated, typically weekly or so, until there is a marked decrease in how they appear.
The four key reasons that we might find behind the failure of cryotherapy are:
The freezing probe has to be in contact with the lesion for a sufficient amount of time for the target temperature to be reached, and then remain at the target temperature for sufficient length of time for the best effect. In reality, this is not achieved due to a combination of patient factors, clinician factors and the limitations of cryotherapy technology being used.
Sufficient amount of time has to pass after initial freezing so that tissue is back to the normal temperature, before the next cycle of freezing is to be applied. If the thawing is incomplete, the next cycle of freezing would be insufficient.
Individual variations among clinicians
Patients often report that their lesions responded better when treated by A compared to B.
In practice, the way cryotherapy is applied varies greatly between the clinicians, and this does result in a difference of response to the treatment. This is due to some clinicians being able to achieve near-perfect freezing-thawing patterns whilst others who do not.
Variations amongst Cryotherapy equipments
Not all cryotherapy equipment is the same. There are a whole range of medical devices for administration of cryotherapy, from portable cryosurgical systems (for example, Histofreeze) to Cryotherapy jars (liquid taken on a cotton tip and applied to the lesions), Cryo-jet sprays (cryojet sprayed to the lesions from a distance) to Cryo Cylinder with metal applicators on the tip for direct contact with the lesions). The type of equipment your clinician has access to can alter the effectiveness of treatment.
Pain with Cryotherapy
Cryotherapy is typically applied without any local anaesthesia. Because of the freezing and thawing effect, you will experience some burning discomfort during the treatment session. Most patients are able to receive reasonable treatment but there are few who will not tolerate it due to pain.
Tolerance to the pain during cryotherapy may come as a barrier to how effectively cryotherapy can be applied during the treatment session. In addition, the level of pain experienced can vary between different cryotherapy equipment designs.
Physical removal of the lesions under local anaesthetic is done using a sharp instrument or via curettage. This provides instant removal, however can create a larger wound than hyfrecation or laser, and is more likely to result in pain, bleeding or permanent skin changes. It can also result in more permanent and/or extensive scarring.
Topic creams are applied on a regular basis, with the course of treatment lasting weeks to months. Unfortunately, the range of (validated) topical creams for various genital lumps & bumps are rather limited.
Wait and See
In many cases, treatment of the genital lumps and bumps are a cosmetic procedure. As such, they do not require any treatment.
One treatment option is “no treatment” (or what is sometimes called “wait and see”). There is no guarantee when (or if) the genital lumps & bumps may disappear, but this is an option that everyone should at least consider.
Comparison By Condition
In our experience, hyfrecation and laser are the most advanced and effective ways of treating the lesions with immediate removal of the lesions, and far superior to cryotherapy.
The successful outcome of the procedure to treat the lesions depends as much on the type of treatment being used as on the expertise and the experience of the clinician treating you. As a result, it also becomes difficult to provide exact statistics as to its effectiveness (though we have a very good idea).
Which treatment option is right for me?
Why does Clarewell Clinics only offer Hyfrecation and not Laser?
For the range of conditions we treat, we find hyfrecation to be the right method of treatment. The key reason for this is that our patients should not need laser treatment for optimal results (this is not necessarily the case the other way around).
However, whether one is treated with hyfrecation or laser, what really matters is the experience and skill of the clinician using the technology. Our clinicians have seen patients throughout the UK (and abroad) to receive treatment from us - often after having a poor response elsewhere.
If I have been treated with another method, can I still be treated with hyfrecation?
There is no clear answer as to which method of treatment is right for you as everyone's circumstances can vary.
We would recommend discussing this with your GP - you can of course book a consultation with us as well - to determine which method is right for you, if at all needed.
Why have I heard about laser treatment but not Hyfrecation?
It is almost impossible that you did not read about lasers in your school years or did not come across the use of lasers in everyday electronic items like toys, TV and phones! Laser was first used in medical practice in 1987 for eye surgery, and high-end lasers are now routinely used for delicate and complex surgeries.
Lasers are excellent where extremely precise cuts need to be made. Lasers have been promoted a lot more heavily, especially in aesthetics practice, by commercial organisations.
On the other hand, hyfrecation, a type of electrosurgery, has been used in the operation theatres of hospitals for much longer!
Being a mainstream medical grade product, it does not get much coverage. In fact, hyfrecation is can be seen used on a daily basis in the following specialties:
- Plastic Surgery
Why are all these treatment methods not available everywhere?
The availability of the different methods can vary depending upon:
- The key areas of focus in the clinic/hospital
- Specialists to carry out the procedure (and train others)
- The versatility of the equipment
- The cost of running the equipment
Generally speaking, sexual health clinics in the NHS commonly use cryotherapy for treatment for warts as it is an inexpensive treatment, easy to administer, and staff are easy to train to spray the lesions with liquid nitrogen.
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Reviewed by: Dr. Manoj Malu (Clinical Director)
Last reviewed date: 1 September 2022
Next review due: 1 September 2025
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.