Cryotherapy for treatment of Keloids
Cryotherapy, also known as Cryosurgery is the application of extreme cold to treat, or destroy keloids. Cryotherapy is the most effective, safest, most economical, and easy-to-perform method of treating most keloid lesions as well as hypertrophic scars. See "Cryotherapy in the treatment of keloids." The success of cryotherapy, like any other medical procedure is simply dependent on the expertise of physician using this method. Having treated over 800 keloid patients, and mostly with cryotherapy, Dr. Tirgan has developed his own unique method of applying cryotherapy which allows for successful removal of many keloid lesions. Please keep in mind that cryotherapy is indicated for certain types of keloids and its efficacy varies from patient to patient and from keloid to keloid.
Cryotherapy is Dr. Tirgan's choice of treating most keloids in children, specially earlobe keloids in African American Children. Recurrence rate after successful removal of keloids with cryotherapy depends on a number of factor, including type, size and location of keloid lesions, as well as presence of keloids elsewhere and the family history of the disorder.Cryotherapy is used to treat a number of skin conditions like warts, moles, skin tags, etc.
Cryotherapy utilizes Liquid Nitrogen that is capable of producing extreme low temperatures. About 80% of the air we breathe is made of nitrogen. Nitrogen is an inert gas and does not react with anything. It is not flammable either. Under extreme pressure, air and specially nitrogen, transforms shape and becomes liquid. Upon evaporation, liquid nitrogen produces extreme cold, -196 Celsius.Application of liquid nitrogen to keloid tissue results in freeze destruction of keloid tissue. Exposure to extremely cold temperatures for an extended period of time causes frostbites which can lead to loss of finger and toes in mountain climbers who are not well prepared. We utilize the same principal in treating keloids, and induce very precise frostbite in the keloid tissue by direct application of liquid nitrogen to the keloid. Videos below depict my standard method of applying Cryotherapy to Keloids.
Application of cryotherapy is an art. Every keloid has a unique shape and configuration. In freezing keloids, attention has to be given to the location, shape and size of keloids. Every patient poses a unique challenge; therefore a careful cryotherapy plan has to be devised for each patient.Prior to initiating cryotherapy, several factors have to be taken into consideration. Application of cryotherapy can be uncomfortable and at times painful. Furthermore, everyone has a different pain tolerance is and each segment of skin has its own unique sensitivity to pain. Therefore, there cannot be one plan and one method of freezing that can be applied to all keloids and to all patients. Constellation of all these variables calls for design of an individualized cryotherapy plan, an art that can be mastered only by experience.
What Happens Afterwards:
Upon application of Liquid Nitrogen to the skin, you may feel a slight burning sensation or pain. The degree of discomfort from cryotherapy depends on the location and size of keloid. Application of Liquid Nitrogen to the large keloids can be uncomfortable and require local anesthesia and pain medications. A large keloid should not be frozen in one session. After completion of cryotherapy, there can be a short term surge in pain within the first hour. This is triggered by the thawing process of frozen keloid.After completion of therapy, the treated keloid and surrounding skin will feel sensitive. Pain and discomfort usually subsides the next day. The keloid will swell up and may even form a large blister in the first 24 hours. The keloid should be kept covered for the next few days with cotton gauze and paper tape. The swollen keloid will gradually ooze and leak yellowish and at times bloody fluid. The amount of swelling and oozing depends on the size of treated keloid. This continues for 5-7 days before the keloid tissue dries out and forms a dark or black color scab and starts to shrink. From this point on, and over next few weeks, the keloid will become gradually drier, transform into a black color scab, and gradually shrink in size.
After 2-3 weeks, the edges of the scab will start separating from the underlying keloid. O once the separation process is completed, the scab will fall off completely. This usually occurs about 4-6 weeks after the application of cryotherapy.You should not force the separation of the scab from the keloid. The site of treated keloid should be kept clean and dry. Using a Q-tip or cotton swabs, the edges of keloid, and where it comes in contact with normal skin should be cleaned. Cleaning can be facilitated with using Hydrogen Peroxide or Iodine Solution. Gently moist the Q-tip in either solutions and clean the edges of keloid.I advise patients to return to the office one week after Cryotherapy in order to assess the impact and efficacy of the treatment. At this visit, if the keloid still appears alive, a second Cryotherapy is applied to the keloid. It is also very important not to scratch or irritate the treated keloid. Treated area can be washed as usual. Shaving blades should not be used over or near the treated keloid.Once the scab falls off, the keloid is considerably smaller and is ready for the next treatment. Most keloids need 2-3 treatments to achieve desirable results. After the scab falls off the underlying skin will appear pink and without any pigments. Time to normalization of skin color after Cryotherapy is variable. Skin color will gradually normalize over time. This process may take several weeks to months.
Cryotherapy is a painful procedure, specially for large keloids. The degree of discomfort and pain from cryotherapy depends on the location and size of keloid. Using Tylenol or Ibuprofen may be enough for managing pain after cryotherapy for small size keloids. On the other hand, treating larger keloids, and those that are in central chest area may need stronger medicines. Dr. Tirgan will advise you as to the expected pain and proper pain management for your particular type of keloid.
A better alternative to oral pain medicines is usage of a new medication called "Exparel" to induce local anesthesia. Regular local anesthetics provide pain relief that usually wears off in about an hour, however, Exparel, once injected into the skin, will induce a durable anesthesia, with its effect lasting up to three days. The only draw back is the actual cost of this medicine.