Lola Dabiri, IP and superintendent pharmacist at Alpha Pharmacy & Clinic – a private independent pharmacy offering a range of services in Aberdeen – talks to Saša Janković about running a cryotherapy clinic.

Service type: Cryotherapy clinic

Name and location of pharmacy: Alpha Pharmacy & Clinic, Aberdeen

Name of superintendent pharmacist: Lola Dabiri

When did you start offering this service?

I did my training just before Covid hit in 2020 which made the service a little too close for comfort to run for a while, but then when things reopened again I restarted it.

Why did you start offering this service?

My pharmacy does not have an NHS contract but I offer private services that meet a need in my local community and/or are not offered by the NHS or GPs any more. I know many people spend a lot of money on verruca treatments so I investigated cryotherapy and decided to offer it as a service since it has a scientific basis and people can no longer access it at their GP surgeries.

How much did it cost to set up the service?

The cost varies depending on where you go for training. Mine cost about £2,000 but included a starter set of liquid nitrogen.

What, if any, training did you or other team members have to undergo?

I did theory based training first, followed by the practical element of how to administer the treatment.

In a nutshell, what does the service involve?

Cryotherapy is used for treating benign lesions such as warts on fingers and toes, skins tags, verrucas, pigmentation, milia and even genital herpes. The lesion is frozen using pressurised liquid nitrogen applied from the nozzle of a canister about the length of a mobile phone. The amount of liquid nitrogen applied depends on the size of the lesion, so patients could need two treatments. The second appointment is usually four weeks later as skin takes about four weeks to regenerate. Tiny lesions mostly need one treatment, but if  they are quite big they are likely to need a second session. It’s important to manage the patient’s expectation about this.

The pre- and post-treatment care is very important. Before the treatment I need to do a thorough consultation and explore exclusion criteria. Clients are advised some medications such as NSAIDs and anticoagulants could affect results (meaning longer treatment times for some). I advise patients taking antihistamines they have to stop them at least 48 hours before as they work against the mode of action of liquid nitrogen, which causes histamines to work through the layers of skin to treat the lesion. Interestingly, if the patient has multiple verrucas close together on the sole of the foot you only have to treat one and the body sends the message to the others via the layers of the skin. Signing of a consent form electronically or otherwise is important before treatment.

After treatment care is simple. There is no special care except for facial treatment where sunblock would be advised, especially during summer months and, again, expectations should be managed appropriately.

Some patients are not suitable for cryotherapy, such as those prone to keloids, and generally we don’t treat children under the age of two as they tend not to get warts or verrucas – although we can treat children of any age as long as they and their parent/guardian is comfortable.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

If a patient has skin tags on the face we sell a cryoblock moisturiser for around £10 which reduces redness in the area after treatment.

How have patients responded to the service?

I haven’t advertised the service widely or via GPs because it started during the pandemic and the lockdowns have meant it’s been on and off since then, but I’ve definitely noticed we’ve had referrals by word of mouth from satisfied customers.

How much do you charge for the service?

I charge between £45-85 depending on the amount of liquid nitrogen needed, which is calculated by the number of seconds of administration required based on the size of the lesion. If a patient is going to need two sessions I usually take payment for both up front, as this makes it more likely that they will return for the second treatment.

Would you recommend offering this service to other contractors?

Yes, especially if you are an IP with advanced clinical skills, as you can do this if it is in your scope of practice and confidence. If you already have an NHS contract then something like this is a great addition to your service offering, but don’t forget to get insurance cover for cryotherapy practice. There is a wide range of insurance available – some as low as £350 a year – or you may already be covered by your current insurance.

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