Between 2006 and 2016, 3677 patients with sporotrichosis were treated at Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, and 199 (5·4%) of them underwent cryosurgery sessions. Cryosurgery was indicated due to incomplete response of oral therapy (improvement but not cure) and to failure of antifungals (no improvement despite high doses) (91·0%); chronic verrucous or extensive ulcerated and vegetative lesions (6·0%) and suspension of antifungals due to adverse reactions (3·0%) (Fig. 1a). The sessions were carried out monthly until clinical cure (re?epithelialization, absence of crusts and infiltration), using a liquid nitrogen spray gun (Fig. 1b–d). In each session, lesions were treated with double freeze–thaw cycles, intermittent spray technique, with freeze time depending on the lesion size. Sporotrichosis was diagnosed based on the isolation of Sporothrix spp., and all patients were being treated with itraconazole (100–400 mg) (67·3%), terbinafine (250–500 mg) (14·1%) or both (18·6%), together or in distinct periods.

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