Intralesional Cryotherapy for the Treatment of Keloid Scars

Evaluating Effectiveness

Michiel C. E. van Leeuwen, MD; Anne Eva J. Bulstra, BSc; Johannes C. F. Ket; Marco J. P. F. Ritt, MD, PhD; Paul A. M. van Leeuwen, MD, PhD; Frank B. Niessen, MD, PhD

Disclosures

Plast Reconstr Surg Glob Open. 2015;3(6):E437 

In This Article

Abstract and Introduction

Abstract

Background: Intralesional (IL) cryotherapy is a novel treatment technique for keloid scars, in which the scar is frozen from inside. Over the past decade, several studies have been published with varying outcomes. A critical analysis of the current literature is, therefore, warranted to determine whether IL cryotherapy is an alternative to established keloid scar treatments.

Methods: A comprehensive review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed and EMBASE were searched from inception. Studies and level of recommendation were graded according to the American Society of Plastic Surgeons criteria.

Results: Eight studies meeting the inclusion criteria were selected. The average scar volume decrease ranged from 51% to 63%, but no complete scar eradication was achieved on average. Scar recurrence ranged from 0% to 24%. Hypopigmentation posttreatment was seen mostly in Fitzpatrick 4–6 skin type patients. Finally, complaints of pain and pruritus decreased significantly in most studies.

Conclusions: IL cryotherapy for the treatment of keloid scars shows favorable results in terms of volume reduction and alleviated complaints of pain and pruritus. However, no complete scar eradication is established, and recurrences are seen. Also, persistent hypopigmentation proved a problem in Fitzpatrick 4–6 skin type patients. Summarized, the evidence proved limited and inconsistent resulting in an American Society of Plastic Surgeons grade C recommendation for this type of treatment of keloid scars.

Introduction

In predisposed individuals, injury of the skin can lead to an abnormal healing response, resulting in keloid scars.[1] Besides aesthetic disfigurement, keloids can cause major physical complaints of pain and pruritus, hence impairing the quality of life of the patient.[2] The treatment of keloids is a great challenge, as surgical excision alone results in high recurrence rates (>60%) and even growth stimulus following treatment.[1] To date, several treatment modalities exist, but not a single treatment option has proven widely effective.[3,4] First-line nonsurgical treatment options include silicone sheeting, pressure therapy, intralesional (IL) corticosteroids, and IL 5-fluorouracil.[3,5] The evidence for effectiveness of silicone sheeting and pressure therapy remains limited.[5] IL corticosteroids and 5-fluorouracil have proven successful in reducing pain and pruritus, as well as decreasing scar volume. However, several painful treatment sessions are required and recurrence rates remain high.[4]

If these nonsurgical treatment options fail, surgical excision with adjunctive radiation is considered the most effective treatment protocol.[6] It allows for complete scar eradication with low recurrence rates.[7] This therapy is, however, not suitable for children (<12 years) or patients with keloids that cannot be closed primarily or are located near radiosensitive organs such as the thyroid gland.[8]

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