Keloid Treatments with Cryotherapy

Does Cryotherapy Effectively Treat Keloids?
Cryotherapy to treat keloids is also called cryosurgery and will typically be done at your physician’s office. Smaller keloids, such as those from acne, are best treated with contact or spray cryotherapy methods.

However, recently, an intralesional process was introduced which applies liquid nitrogen directly inside of the keloid, and has been proven to be effective for treating larger keloids.
Whether used by itself or in combination with other therapies, keloid treatment with cryotherapy is considered to be a first-line treatment option. Many times, it is effective for softening tough keloids and is used before a steroid injection- making the injection easier and helping to disperse corticosteroid medications much better.

What Happens During Cryotherapy Treatment?

Contact Cryotherapy
The keloid will be cleaned with disinfectant to get started. Then, a 1 centimeter metal probe that is attached to the cryo-gun will be laid on the surface of the keloid. Then, the liquid nitrogen will be released onto the keloid until ice begins to form and spreads to the edge.

Cryo-Spray
In this method of cryotherapy, the liquid nitrogen is sprayed directly onto the surface of the keloid surface to cover it. The skin will then be allowed to thaw out. If more than one application is needed, the skin will thaw between each one. This seems to be a much more effective method than the dipstick applicator since it reaches deeper into the keloid.

Intralesional Cryosurgery
After the keloid has been cleaned with disinfectant, the keloid itself as well as the underlying tissue will be numbed with an injection. Then, the keloid will be pinched in one hand, as the two prongs of the cryo-needle (attached to the cryo-gun) are pushed into the scar approximately 5 millimeters and will run parallel across the longest part of the keloid until it reaches the other side.
At this time, the liquid nitrogen is released and ice balls will begin to form where the probes are inserted.

Ice will form and the two balls will connect, which reveals that the keloid has been completely frozen.
Then, the flow of the nitrogen ceases, but the probes are left in for a few moments so that it can thaw out before being pulled out. Sterile gauze will be placed on the keloid to cover the site of penetration.
Until it is fully healed, you should be cleaning the wound on a daily basis and applying antibiotic ointment to it.

Things to Expect Before/After Keloid Treatment with Cryotherapy

If you have keloids and choose to use cryotherapy treatments, you will be given a local anesthesia for contact or spray cryotherapy. If your keloids are unresponsive after undergoing six sessions, the experts suggest that you may see results if you combine corticosteroids with cryotherapy.

How Often Should You Use Cryotherapy?
This varies, according to the severity of your keloids. However, cryotherapy treatment sessions are typically repeated as needed every 20 to 30 days.

What is the Typical Dosage for a Cryotherapy Treatment?
While the depth of the keloid determines the number of cycles you will need for treatment, you will find that you will typically undergo between 1 to 3 freeze/thaw cycles for a duration of 10 to 30 seconds each.

Is Cryotherapy a Painful Process?
The truth is that yes, it is quite painful. In fact, it seems that most of the time, patients do not continue with treatment after the first one because of the pain they experience.

What are the Side Effects Associated with Cryotherapy?
In many cases, you may experience blistering and swelling following a cryotherapy treatment. You may also notice that you have some skin discoloration in the months following a procedure. You may have permanent hyperpigmentation as a result of cryotherapy, especially in patients who have darker skin tones. If you have cryotherapy performed on temple and forehead keloids, you may experience headaches as well.

How Does This Procedure Work?
Cryotherapy works by damaging the cell tissue, causing the keloid to flatten and come off. When this therapy is used in conjunction with steroid injections, you will only need a light application to soften the keloid- and you will experience some mild swelling.
As mentioned, patients may experience skin discoloration. This is because the melanocytes, or the cells that produce pigments are located near the surface of the skin and are often sensitive to cold temps.

It has been said that the intralesional method results in moderate, longer-lasting reductions in temperatures. This is in contrast to the contact and spray therapies- as the tissue that gets coldest is deep inside the scar instead of on the surface, which means it’s less likely to damage the melanocytes.

Evidence of Cryotherapy Benefits
When used alone, the rate of response associated with cryotherapy is good when it comes to keloids that have recently formed. However, the truth is, it works much better when it’s used in conjunction with steroid injections.

It seems that intralesional cryosurgery is a viable option due to the risk of hyperpigmentation associated with spray/contact cryotherapy. After all, hyperpigmentation can be a permanent negative side effect. Therefore, any reduction is critical for making an even more attractive option for treating keloids, since there is a zero chance that the keloids will come back.