Cryosurgery for Acne Keloids

Acne keloids leave deep scars that are extremely tough to treat. Two options available are cryosurgery or cryotherapy and intralesional corticosteroid injections.  The aim of cryosurgery is to freeze scars using liquid nitrogen that damages the skin tissues.

Benefits of cryosurgery

Cryosurgery is the treatment of choice for keloid scars. Clinical assessments conducted about 8 weeks after treatment assessed the size of keloids, blood flow within them and the palpability. Cryosurgery had good effect on less palpable keloids and those that are not so flat. Keloid scars on the back responded the best followed by those on the trunk and face.

The side effects experienced after cryosurgery is minor and do not last long. Other benefits include low cost, excellent cosmetic results and ease of use.  Patients do not require hospitalization or an anesthetic. Multiple keloid scars can be treated during a single sitting. The doctor does not have to worry when treating HIV positive patients since it is a no-touch technique.

Procedure and Cost of cryosurgery

Cryosurgery is an in-office procedure performed by dermatologists. In cryosurgery, keloid scars are frozen using extremely cold liquid nitrogen. Scars are treated with liquid nitrogen, which is applied using a sprayer or cotton ball. Application time can range from 10 seconds to around 2 minutes. This application causes the keloids to die and fall off eventually. After treatment, the tissue dies, is sloughed off and the area gets flattened. This improves the appearance of the affected areas.

This treatment results in necrosis – that causes cells to alternately freeze and thaw. Skin tissue reepithelializes after treatment. Cryosurgery for acne

The mechanism of action in this procedure involves three stages – heat transfer, cell injury and inflammation.

Liquid nitrogen that is used reaches boiling point at -196°C. When the spray technique is used, the liquid nitrogen is sprayed directly on keloid scars. The heat on the skin’s surface transfers to liquid nitrogen that causes it to evaporate (boil) at once. Sometimes a cryoprobe is used when heat is transferred using a copper-metal probe.

Once the cell is frozen, thawing occurs and cell injury takes place. Quick freezing and slow thawing causes cell destruction and results in keloid scars falling off. The final response to cell death during cryosurgery is inflammation – erythema and edema. 

Patients usually do not require a local anesthetic if spray or contact cryosurgery is performed. 
The cost depends on the number of scars that are treated ranging between $75 and $150 per scar. Around 2-10 sessions may be required to achieve optimum results. Blistering usually heals in about 3 weeks.

Possible Issues with cryosurgery

Some side effects of cryosurgery include:

  • Blistering
  • Pain
  • Swelling
  • Atrophy
  • Bleeding or fainting, which is very rare
  • Hyperpigmentation or skin darkening
  • Hypopigmentation or skin lightening that can be permanent, for freezing for long periods, can kill the pigment cells melanocytes. 

A limitation of cryosurgery is that it does not treat grossly palpable keloids and flatter keloids. 

Acne lesions may require multiple sessions before resolution is observed.   Sprayed areas may take 1-3 weeks to get cured until which time a blister will be present. Skin discoloration may occur due to cell destruction.   Hemorrhages can occur very rarely.  Some dermatologists are of the opinion that keloid scars are extremely difficult to treat and cryosurgery should be opted for only when other standard management techniques have failed.

If keloids do not respond after 6 sessions, some doctors could suggest combining this therapy with corticosteroid injections. 

Precautions

Cryosurgery cannot be done anywhere in the vicinity of eye margins.   If the procedure has to be performed near the ear or nose, it must be done only by experienced professionals using specialized equipment.  

It is contraindicated for those who suffer from cold intolerance, or have a history of pyoderma gangrenosum, cryoglobulinemia, allergic to cold temperatures and Raynaud disease. It is important to be aware of complications and report them to the doctor at once.  Others who cannot undergo cryosurgery are those taking immunosuppressive drugs, suffer from cancer or have vasospastic disorders. 

After treatment, the area must be monitored closely for patients can develop similar scars if they are not careful.  Cryosurgery can only be performed by qualified and experienced doctors.