Cryotherapy for Treatment of Keloids:
Cryotherapy, also known as Cryo-surgery 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 bulky and thick keloids.
The success of cryotherapy, like any other medical procedure is simply dependent on the expertise of physician using this method. 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, especially ear keloids.
Recurrence rate after successful removal of keloids with cryotherapy depends on several factors, including type, size and location of keloid lesions, as well as presence of keloids elsewhere and the family history of the disorder.
The video below demonstrates how cryotherapy is applied to an ear keloid.
Application of cryotherapy is an art. Every keloid has a unique shape and configuration. In freezing keloids, attention must be given to the location, shape and size of keloids. Every patient poses a unique challenge; therefore, a careful cryotherapy plan must be devised for each patient.
A common mistake in applying cryotherapy to a keloid is assuming that one can simply spray liquid nitrogen on the keloid by using a liquid nitrogen spray gun. This method of cryotherapy is highly ineffective. Although using a spray gun may cause the surface of keloid to appear frozen, quite often, the deep tissue remains untreated. As a result, treatment does not achieve the desired results and yet, it causes the pain and discomfort. Worse yet, the treating physician concludes that the cryotherapy was ineffective.
Prior to initiating cryotherapy, several factors have to be taken into consideration. Cryotherapy is a painful procedure, especially for large keloids. Proper pain control is the most important factor in using cryotherapy to treat keloids.
Cryotherapy of small keloids, measuring up to half an inch (1.25 cm) in diameter, although it can cause some pain, the discomfort is manageable and often does not require any intervention. Keeping busy and distracted for several hours after treatment is all that is needed to manage the discomfort of treatment. If needed, patients can take Tylenol or Ibuprofen.
Treatment of keloids that are larger than half an inch (>1.25 cm) will naturally cause more discomfort and more pain – something that will require further attention and proper management. Naturally, application of cryotherapy to larger keloids is associated with more pain.
Pain of cryotherapy is short-lived and often subsides within 8-12 hours. The peak intensity of the pain occurs 1-2 hours after the procedure. A simple local anesthetic may be all that some patients will need to overcome this pain. However, as the pain tolerance is variable among individuals, some patients will need to take acetaminophen, Ibuprofen, or even codeine for pain control.
Application of cryotherapy to lesions that are larger than one inch requires proper planning and adequate pain control measures. Although larger doses of narcotic pain medications can help with managing the pain, a better alternative to oral pain medicines is the usage of a durable local anesthetic medication called "Exparel".
Regular local anesthetics provide pain relief that usually lasts about an hour. However, Exparel once injected into the skin will induce a durable anesthesia that lasts up to three days. Despite proper usage of this medicine, there are patients who will still experience pain that will need to be properly managed.
During your consultation, Dr. Tirgan will advise you on how much pain you may expect, depending on the unique type, size, and location of your keloids. He will also provide you with a proper pain management plan for your keloid.
What Happens Afterwards?
After the application of cryotherapy, treated keloid and the surrounding skin will swell up to form a large blister that often grows and becomes twice the size of the keloid, or even larger. It is best to use cotton gauzes and paper tapes to bandage and cover the treated areas for the next several days after treatment. The swollen keloid will gradually ooze and leak yellowish and at times blood-tinged fluid. The amount of swelling and oozing depends on the size of the treated keloid; this continues for 5-7 days, at which point the keloid tissue starts to dry out and form a dark or black color scab. From this point on, and over the next few weeks, the keloid will gradually become drier, transforms into a black color scab, and gradually contracts and reduces in its size.
Two to three weeks later, the edges of the scab will start to separate from the underlying skin. Once the scab is completely separated, it will fall off completely. This usually happens about 4-6 weeks after the application of cryotherapy. You should not force the separation of scab from the keloid. The site of treated keloid should be kept clean and dry. Using a Q-tip or cotton swabs, clean the edges of the keloid, and also clean the areas where the keloid comes in contact with normal skin. Gently dip the Q-tip in a small amount of water, gentle soap water, or Iodine Solution to clean the edges of a keloid. It is also very important for patients not to scratch or irritate the treated keloid. Treated areas 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-to-3 treatments to achieve desirable results. After the scab falls off the underlying skin will appear pink and without any pigments. Skin color will gradually normalize over time; the normalization process is variable and may take several months.
To learn more about cryotherapy for treatment of keloids, you can download the KRF Guidelines for Cryotherapy, authored by Dr. Tirgan.