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Outcomes of Cryosurgery in Keloids and Hypertrophic Scars: A Prospective Consecutive Trial of Case Series

Outcomes of Cryosurgery in Keloids and Hypertrophic Scars: A Prospective Consecutive Trial of... Abstract Background and Design: A variety of therapeutic regimens has been used in keloids and hypertrophic scars with unsatisfactory final results. Application of cryosurgery could be beneficial since it was reported to produce less scarring after treatment of skin tumors compared with other surgical procedures. We performed a prospective consecutive trial of randomly enrolled case series including 32 months of average follow-up to assess the outcomes of cryosurgical treatment in keloids and hypertrophic scars and to determine factors influencing the therapeutic result. Ninety-three white patients, aged 10 to 79 years (median age, 26 years) with keloids (n=55; median duration, 36 months; median size, 4 cm2) and with hypertrophic scars (n=38; median duration, 12 months; median size, 2 cm2) were treated using the contact method. One freeze-thaw cycle of 30 seconds per lesion and session was employed, and, if needed, treatment was repeated every 20 to 30 days. Results: Excellent responses (ER) were recorded in 30 subjects (32.3%), good responses (GR) in 27 (29.0%), poor responses (PR) in 27 (29.0%), while nine subjects (9.7%) did not respond at all. Hypertrophic scars responded better (n=38; GR to ER, 76.3%) than keloids (n=55; GR to ER, 50.9%; P<.005; odds ratio, 6.92). No progressions or recurrences occurred. Histologically, neovascularization, loss of the anarchic arrangement of collagen bundles, increased fibroblasts in a stroma running parallel to the skin surface, and mononuclear cells mostly arranged at the perivascular area were found in clinically responding lesions. Improved responses were detected in subjects treated with three or more sessions (n=57; GR to ER, 78.9%) compared with subjects treated once or twice (n=36; GR to ER, 33.3%; P<.001; odds ratio, 13.68). The cryosurgical treatment was generally well tolerated, with local pain during freezing and/or shortly after treatment (n=32, 34.4%) and hypopigmentation or hyperpigmentation (n=11, 11.8%) being the most frequent side effects. Conclusions: Cryosurgery was found effective and safe in keloids and, especially, in hypertrophic scars, in an open, uncontrolled study. Satisfactory results could be obtained after at least three cryosurgical sessions of 30 seconds each, applied once monthly using the contact method of treatment.(Arch Dermatol. 1993;129:1146-1151) References 1. Muir IFK. On the nature of keloid and hypertrophic scars . Br J Plast Surg. 1990;43:61-69.Crossref 2. Datubo-Brown DD. Keloids: a review of the literature . Br J Plast Surg. 1990; 43:70-77.Crossref 3. Peacock EE Jr, Madden JM, Trier WC. Some studies on the treatment of keloids and hypertrophic scars . South Med J. 1970;63:755-760.Crossref 4. Kelly AP. Keloids . Dermatol Clin. 1988;6:413-424. 5. Rudolph R. Widespread scars, hypertrophic scars, and keloids . Clin Plast Surg. 1987;14:253-260. 6. Brown LA Jr, Pierce HE. Keloids: scar revision . J Dermatol Surg Oncol. 1986; 12:51-56.Crossref 7. Shepherd JP, Dawber RPR. The response of keloid scars to cryosurgery . Plast Reconstr Surg. 1982;70:677-681.Crossref 8. Meltzer L. A cryoprobe for the therapy of linear keloid . J Dermatol Surg Oncol. 1983;9:111-112.Crossref 9. Graham GF. Cryosurgery for acne . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby—Year Book; 1985:59-76. 10. Mende B. Keloidbehandlung mittels Kryotherapie . Z Hautkr. 1987;62:1348-1355. 11. Zouboulis ChC, Orfanos CE. Kryochirurgische Behandlung von hypertrophen Narben und Keloiden . Hautarzt. 1990;41:683-688. 12. Ernst K, Hundeiker M. Kryochirurgische Behandlung von Keloiden . Akt Dermatol. 1990;16:107-109. 13. Layton AM, Cunliffe WJ. A double blind controlled trial of cryotherapy and triamcinolone in the treatment of acne keloids . Br J Dermatol. 1991;125( (suppl) ): 41-42.Crossref 14. Elton RF. The course of events following cryosurgery . J Dermatol Surg Oncol. 1977;3:448-451.Crossref 15. Shepherd J, Dawber RPR. The historical and scientific basis of cryosurgery . Clin Exp Dermatol. 1982;7:321-328.Crossref 16. Ceilley RI, Babin RW. The combined use of cryosurgery and intralesional injections of suspensions of fluorinated adrenocorticosteroids for reducing keloids and hypertrophic scars . J Dermatol Surg Oncol. 1979;5:54-56.Crossref 17. Hirshowitz B, Lerner D, Moscona AR. Treatment of keloid scars by combined cryosurgery and intralesional corticosteroids . Aesth Plast Surg. 1982;6:153-158.Crossref 18. Glazer SF, Sher AM. Adjunctive cryosurgery in the surgical approach to keloids . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby—Year Book; 1985:91-95. 19. Sebastian G, Scholz A. Unsere Erfahrungen mit konservativen Therapiemethoden bei hypertrophen Narben und Keloiden . Dtsch Derm. 1990;38:872-877. 20. Kischer CW, Shetlar MR, Chvapil M. Hypertrophic scars and keloids: a review and new concept concerning their origin . Scan Electron Microsc. 1982;IV: 1699-1713. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Outcomes of Cryosurgery in Keloids and Hypertrophic Scars: A Prospective Consecutive Trial of Case Series

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1993.01680300074011
Publisher site
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Abstract

Abstract Background and Design: A variety of therapeutic regimens has been used in keloids and hypertrophic scars with unsatisfactory final results. Application of cryosurgery could be beneficial since it was reported to produce less scarring after treatment of skin tumors compared with other surgical procedures. We performed a prospective consecutive trial of randomly enrolled case series including 32 months of average follow-up to assess the outcomes of cryosurgical treatment in keloids and hypertrophic scars and to determine factors influencing the therapeutic result. Ninety-three white patients, aged 10 to 79 years (median age, 26 years) with keloids (n=55; median duration, 36 months; median size, 4 cm2) and with hypertrophic scars (n=38; median duration, 12 months; median size, 2 cm2) were treated using the contact method. One freeze-thaw cycle of 30 seconds per lesion and session was employed, and, if needed, treatment was repeated every 20 to 30 days. Results: Excellent responses (ER) were recorded in 30 subjects (32.3%), good responses (GR) in 27 (29.0%), poor responses (PR) in 27 (29.0%), while nine subjects (9.7%) did not respond at all. Hypertrophic scars responded better (n=38; GR to ER, 76.3%) than keloids (n=55; GR to ER, 50.9%; P<.005; odds ratio, 6.92). No progressions or recurrences occurred. Histologically, neovascularization, loss of the anarchic arrangement of collagen bundles, increased fibroblasts in a stroma running parallel to the skin surface, and mononuclear cells mostly arranged at the perivascular area were found in clinically responding lesions. Improved responses were detected in subjects treated with three or more sessions (n=57; GR to ER, 78.9%) compared with subjects treated once or twice (n=36; GR to ER, 33.3%; P<.001; odds ratio, 13.68). The cryosurgical treatment was generally well tolerated, with local pain during freezing and/or shortly after treatment (n=32, 34.4%) and hypopigmentation or hyperpigmentation (n=11, 11.8%) being the most frequent side effects. Conclusions: Cryosurgery was found effective and safe in keloids and, especially, in hypertrophic scars, in an open, uncontrolled study. Satisfactory results could be obtained after at least three cryosurgical sessions of 30 seconds each, applied once monthly using the contact method of treatment.(Arch Dermatol. 1993;129:1146-1151) References 1. Muir IFK. On the nature of keloid and hypertrophic scars . Br J Plast Surg. 1990;43:61-69.Crossref 2. Datubo-Brown DD. Keloids: a review of the literature . Br J Plast Surg. 1990; 43:70-77.Crossref 3. Peacock EE Jr, Madden JM, Trier WC. Some studies on the treatment of keloids and hypertrophic scars . South Med J. 1970;63:755-760.Crossref 4. Kelly AP. Keloids . Dermatol Clin. 1988;6:413-424. 5. Rudolph R. Widespread scars, hypertrophic scars, and keloids . Clin Plast Surg. 1987;14:253-260. 6. Brown LA Jr, Pierce HE. Keloids: scar revision . J Dermatol Surg Oncol. 1986; 12:51-56.Crossref 7. Shepherd JP, Dawber RPR. The response of keloid scars to cryosurgery . Plast Reconstr Surg. 1982;70:677-681.Crossref 8. Meltzer L. A cryoprobe for the therapy of linear keloid . J Dermatol Surg Oncol. 1983;9:111-112.Crossref 9. Graham GF. Cryosurgery for acne . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby—Year Book; 1985:59-76. 10. Mende B. Keloidbehandlung mittels Kryotherapie . Z Hautkr. 1987;62:1348-1355. 11. Zouboulis ChC, Orfanos CE. Kryochirurgische Behandlung von hypertrophen Narben und Keloiden . Hautarzt. 1990;41:683-688. 12. Ernst K, Hundeiker M. Kryochirurgische Behandlung von Keloiden . Akt Dermatol. 1990;16:107-109. 13. Layton AM, Cunliffe WJ. A double blind controlled trial of cryotherapy and triamcinolone in the treatment of acne keloids . Br J Dermatol. 1991;125( (suppl) ): 41-42.Crossref 14. Elton RF. The course of events following cryosurgery . J Dermatol Surg Oncol. 1977;3:448-451.Crossref 15. Shepherd J, Dawber RPR. The historical and scientific basis of cryosurgery . Clin Exp Dermatol. 1982;7:321-328.Crossref 16. Ceilley RI, Babin RW. The combined use of cryosurgery and intralesional injections of suspensions of fluorinated adrenocorticosteroids for reducing keloids and hypertrophic scars . J Dermatol Surg Oncol. 1979;5:54-56.Crossref 17. Hirshowitz B, Lerner D, Moscona AR. Treatment of keloid scars by combined cryosurgery and intralesional corticosteroids . Aesth Plast Surg. 1982;6:153-158.Crossref 18. Glazer SF, Sher AM. Adjunctive cryosurgery in the surgical approach to keloids . In: Zacarian SA, ed. Cryosurgery for Skin Cancer and Cutaneous Disorders . St Louis, Mo: Mosby—Year Book; 1985:91-95. 19. Sebastian G, Scholz A. Unsere Erfahrungen mit konservativen Therapiemethoden bei hypertrophen Narben und Keloiden . Dtsch Derm. 1990;38:872-877. 20. Kischer CW, Shetlar MR, Chvapil M. Hypertrophic scars and keloids: a review and new concept concerning their origin . Scan Electron Microsc. 1982;IV: 1699-1713.

Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 1993

References