Intralesional Cryotherapy for Keloids: Benefits and Drawbacks

Cryotherapy for keloids

Hello, Doctor.
I have seen that most of the cryotherapy for keloids involves spraying liquid nitrogen directly onto the surface of the lesion.
After researching, I came across a method called "intralesional cryotherapy," where a needle is used to freeze the tissue directly, causing necrosis.
I have seen some images that suggest this method may be effective, but it seems that there is not much information about this approach being used in Taiwan.
Do general hospitals typically perform this method? What are the advantages and disadvantages of this technique?

Kenny, 30~39 year old female. Ask Date: 2020/05/14

Dr. Wu Yuxin reply Dermatology

Indeed, there are some physicians who are performing it, but it's worth asking.

Reply Date: 2020/05/14

More Info

Intralesional cryotherapy for keloids is an innovative treatment approach that involves the direct application of extreme cold to the keloid tissue, typically using liquid nitrogen. This method is distinct from superficial cryotherapy, which only targets the outer layers of the skin. Instead, intralesional cryotherapy penetrates deeper into the keloid, aiming to induce necrosis of the abnormal tissue and promote healing.

Benefits of Intralesional Cryotherapy
1. Targeted Treatment: By delivering cold directly into the keloid, this method can effectively destroy the fibrous tissue that characterizes keloids. This targeted approach can lead to better outcomes compared to superficial treatments.

2. Reduced Recurrence Rates: Studies have shown that intralesional cryotherapy may result in lower recurrence rates of keloids compared to other treatments, such as corticosteroid injections or surgical excision.

3. Minimal Scarring: Since the treatment focuses on the keloid itself and minimizes damage to surrounding healthy tissue, patients may experience less scarring post-treatment.

4. Quick Procedure: The treatment is typically quick, often taking only a few minutes, and can be performed in an outpatient setting.

5. Combination Therapy: Intralesional cryotherapy can be combined with other treatments, such as corticosteroid injections or silicone gel sheeting, to enhance overall effectiveness.

Drawbacks of Intralesional Cryotherapy
1. Pain and Discomfort: The procedure can cause significant pain during and after treatment. Patients may require analgesics to manage discomfort.

2. Risk of Hypopigmentation: There is a risk of skin lightening (hypopigmentation) in the treated area, especially in individuals with darker skin tones.

3. Potential for Infection: As with any procedure that disrupts the skin barrier, there is a risk of infection at the treatment site.

4. Limited Availability: While intralesional cryotherapy is gaining recognition, it may not be widely available in all healthcare settings, including some hospitals in Taiwan. Availability can vary based on the institution's resources and the expertise of the dermatology or plastic surgery departments.

5. Variable Results: The effectiveness of cryotherapy can vary from patient to patient. Some individuals may not respond as well to the treatment, necessitating alternative approaches.

Conclusion
Intralesional cryotherapy represents a promising option for the treatment of keloids, with several benefits that may make it preferable to traditional methods. However, potential drawbacks, including pain, risk of hypopigmentation, and limited availability, should be carefully considered. Patients interested in this treatment should consult with a dermatologist or plastic surgeon experienced in keloid management to discuss the best options tailored to their specific condition.
In summary, while intralesional cryotherapy may not be universally practiced in all hospitals, it is an effective treatment modality worth considering for keloid management, especially for patients who have not responded well to other therapies.

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