Intralesional cryotherapy for hypertrophic scars and keloids: a review

• Published in: Scars, Burns & Healing Burns & Healing, 2017-01, Vol.3, p.2059513117702162-2059513117702162
• Main Authors: O’Boyle, Ciaran P, Shayan-Arani, Holleh, Hamada, Maha Wagdy
• Format: Article
• Language: English
• Subjects: Cryotherapy; Review; Scars
• ISSN: 2059-5131; 2059-5131
• DOI: 10.1177/2059513117702162

Introduction: Hypertrophic and keloid scarring remain notoriously troublesome for patients to tolerate and frustratingly difficult for clinicians to treat. Many different treatment modalities exist, signifying the failure of any method to achieve consistently excellent results. Intralesional cryotherapy is a relatively recent development that uses a double lumen needle, placed through the core of a keloid or hypertrophic scar, to deliver nitrogen vapour, which freezes the scar from its core, outwards. Methods: This article provides a comprehensive review of the literature on intralesional cryotherapy for hypertrophic scars and keloids. A systematic review or meta-analysis was not possible, since the existing articles did not permit this. Results: A search of English language, peer-reviewed literature was carried out. The evidence base was found to be low (level 4). In addition, much of the published evidence comes from a very few groups. Despite this, consistent findings from case series suggest that the technique is safe and achieves good scar reduction with very few treatments. Adverse effects include depigmentation, recurrence and pain. Pain and recurrence appear to be uncommon and depigmentation may be temporary. Discussion: Well-constructed, prospectively recruited comparative trials are absent from the literature. These are strongly encouraged, in order to strengthen general confidence in this technique and in the repeatability of outcomes reported thus far. Lay Summary There are many different types of treatment for hypertrophic scars and keloid scars, but no treatment works perfectly in all individuals. Intralesional cryotherapy is a relatively new technique which freezes a scar from the centre outwards. This article provides a summary of the technique and the evidence for its usefulness in the medical literature. While no large-scale studies have been reported, the findings from small scale studies have been very encouraging. Intralesional cryotherapy appears to be safe and effective, with few adverse effects, but more research is needed in order to compare it adequately with other types of treatment