Current developments and uses of cryosurgery in the treatment of keloids and hypertrophic scars

Abstract

Cryosurgery is currently regarded as the treatment of choice for keloids and hypertrophic scars. Four techniques are established or currently under evaluation in this area. The first is cryosurgery as monotherapy. Using this regimen, 241 of 356 patients (68%) with keloids and 72 of 89 patients with hypertrophic scars (81%), showed a greater than 50% improvement or complete regression (five studies). Using the second technique, cryosurgery with intralesional corticosteroids, significant regression of keloids was found in 119 of 159 patients (75%; four studies). Cryosurgery induces tissue edema and facilitates intralesional injections; however, the combined therapy was not superior (90% greater than 50% reduction of lesional volume) to monotherapy (83.3%) in a study of 40 patients with keloids. The third technique is surgical debulkment prior to cryosurgery without corticosteroids. This regimen is unavoidable in large keloids; however, it can result in recurrences despite its shortterm promising effects. Intralesional cryosurgery, the fourth technique, was developed by modifying the technique by Weshahy and is under evaluation in our department. In addition, histological and immunohistological studies of keloids and keloidal fibroblasts in vitro treated by cryosurgery have detected changes indicating potential rejuvenation of the scars.

Skin scarring

“…Intralesional corticosteroid injection20 is widely used but is prone to complications (fat atrophy, dermal thinning, and pigment changes). Other treatments that have been advocated with variable outcomes include injections of fluorouracil,23 interferon gamma,24 and bleomycin,25 radiotherapy,26 laser therapy,27 and cryosurgery 28…”

Therapy of pathological scars

“…It causes tissue damage due to exposure to cold with vasoconstriction and subsequent ischemia [14]. The scar is sprayed in two freeze-thaw cycles for 10-20 seconds with liquid nitrogen (Figure 12).…”

Keloide und ihre Therapie

“…Die Effekte der Kryotherapie beim Keloid bestehen in einer direkten Zellschädigung sowie in einer veränderten Mikrozirkulation mit Thrombosierung der kleinen Gefäße und einer Gewebsnekrose.Auf zellulärer Ebene kommt es nach Zouboulis et al [30] im Keloid zur Änderung der Tenascin-C-und der Interferon-gamma-Expression. Die Kryotherapie führt zur Hemmung der Fibroblastenproliferation und der Kollagensynthese.Außerdem scheint die Kältetherapie die Differenzierung der Keloidfibroblasten zu normalen Fibroblasten zu beeinflussen [30]. Nebenwirkungen.…”

“…Selten treten verzögerte Wundheilung,Milienbildung oder Wundinfektionen auf.Die verschiedenen Kryotherapieformen führen bei 68% der Keloide zur kompletten Rückbil-dung bzw. zur deutlichen Abflachung [30]. Bei der Kryomonotherapie (Evidenzlevel III) werden minimal 3-5 Therapiesitzungen erforderlich, bevor Aussagen darüber möglich sind, wie die Behandlung anspricht.…”