Cryotherapy with Intralesional Corticosteroids

Compare To Other Treatments

The charts below show the chances of developing various side effects from cryotherapy with intralesional corticosteroid treatment.1-4 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Mild to moderate pain during injectionup to 70%
SHORT TERM Skin blisters filled with water (bullae)up to 64%
LONG TERM Spider veins (telangiectasia)Common (incidence not known)
SHORT TERM Thinning of the skin (skin atrophy)*up to 48%
SHORT TERM Stinging sensationup to 36%
SHORT TERM Delayed wound healingup to 35%
SHORT TERM Transient skin lightening  (hypopigmentation)up to 30%
SHORT TERM or LONG TERM Skin darkening (hyperpigmentation) (how often this was short-term or long-term was not specified)
SHORT TERM Swelling (edema)up to 25%

*Thinning of the skin (atrophy): Thinning of the skin after cryotherapy and intralesional corticosteroid therapy makes the skin look sunken in, and usually resolves between 6 months and 1 year after treatment. In some cases, this side effect may take longer to disappear.

Possible/Rare Side Effects

LONG TERM Longer-term skin lightening (hypopigmentation)up to 4%

Studies:  

Four studies have looked at the side effects of cryotherapy with intralesional corticosteroid treatment.

  • Study 1:

    • Authors: Nishi and Rajasheter1
    • Total # of patients: 170
    • # of female patients: 79
    • # of male patients: 91
    • Age of patients: 20-50
    • Treatment type: Cryotherapy followed by intralesional 40 mg/ml of triamcinolone
    • Duration of treatment and follow-up: 4 treatments, follow-up for 4 months
    • Side effects:
      • Spider veins (telangiectasia): (most common, but exact percentage was not reported)
      • Thinning of the skin (skin atrophy): 48.2%
      • Skin darkening or lightening (hyperpigmentation or hypopigmentation): 25.8%
  • Study 2:

    • Authors: Yosipovitch et al.2
    • Total # of patients: 100
    • # of female patients: 36
    • # of male patients: 64
    • Age of patients: 10-80
    • Treatment type: Cryotherapy followed by intralesional injection of 40mg/ml triamcinolone
    • Duration of treatment and follow-up: 3-5 treatments, follow-up for 4 months
    • Side effects:
      • Skin blisters filled with water (bullae): 64%
      • Stinging sensation: 36%
      • Reversible skin lightening (hypopigmentation): 30%
      • Long-term skin lightening (hypopigmentation): 4%
  • Study 3:

    • Authors: Jannati et al.3
    • Total # of patients: 80
    • # of female patients: 42
    • # of male patients: 38
    • Age of patients: 10-50
    • Treatment type: Cryotherapy followed by intralesional injection of 40mg/ml of triamcinolone mixed with 2% lidocaine hydrochloride
    • Duration of treatment and follow-up: Number of treatments not reported, follow-up for up to 1 year
    • Side effects:
      • Pain: 70%
      • Spider veins (telangiectasia): 15%
      • Thinning of the skin (skin atrophy): 8%
      • Dispigmentation (skin darkening or skin lightening): (percentage not reported)
  • Study 4:

    • Authors: Zouboulis and Zouridaki4
    • Total # of patients: 40
    • # of female patients: 22
    • # of male patients: 18
    • Age of patients: 14-44
    • Treatment type: Cryotherapy followed by intralesional injection of betamethasone
    • Duration of treatment and follow-up: 3 treatments, follow-up for 6 to 36 months
    • Side effects:
      • Pain: 50%
      • Delayed wound healing: 35%
      • Swelling: 25%
      • Skin lightening (hypopigmentation): 25%

Study 1: In a study published in 2022 in the Journal of Cutaneous and Aesthetic Surgery, Nishi and Rajasheter treated 170 patients with keloids with cryotherapy and intralesional triamcinolone. The patients received cryotherapy for 10-20 seconds and then 40mg/ml of triamcinolone at 1-month intervals up to 4 times or until the scar flattened. While spider veins were the most commonly reported side effect, the authors didn’t state the exact number of patients who experienced this side effect. Thinning of the skin (skin atrophy) occurred in 48.2% of treated patients.1

Study 2: In a study published in 2015 in the Journal of Dental and Medical Sciences, Singh and Kumar treated 100 patients with keloid scars with cryotherapy followed by intralesional injection of 40mg/ml of triamcinolone. The patients received 3-5 sessions at 1-month intervals. Interestingly, most patients (64%) reported skin blisters filled with water (bullae), while 4% of treated patients experienced long-term skin lightening (hypopigmentation).2

Study 3: In a study published in 2015 in the journal Journal of Skin Stem Cell, Jannati and colleagues treated 80 patients with raised scars with cryotherapy plus intralesional triamcinolone. Cryotherapy was applied for 15 seconds and followed by an intralesional injection of 40mg/ml of triamcinolone mixed with 2% lidocaine. Authors reported that patients received as many treatments as needed for the scar to become flat in 3-week intervals and were followed for up to a year. Most patients reported pain at the injection site (70%), followed by the occurrence of spider veins in 15% of treated patients.3

Study 4: In a study published in 2020 in the journal Dermatology, Zouboulis end Zouridaki treated 40 patients with raised scars with cryotherapy and intralesional triamcinolone. The patients received cryotherapy for 30 seconds and 5 minutes later they received 2 mg of betamethasone per cm3 of raised scar. Patients were followed for 6 to 36 months (median: 21 months). 50% of them experienced pain, while 35% had delayed wound healing.4

References
  1. Nishi N, Rajashekar TS. A Comparative Study of Effectiveness of Cryotherapy with Intralesional Triamcinolone Vs Fractional CO2 Laser with Topical Betamethasone for the Treatment of Keloids. J Cutan Aesthet Surg. 15(3), 254-9 (2022).
  2. Yosipovitch G, Widijanti Sugeng M, Goon A, Chan YH, Goh CL. A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study. J Dermatolog Treat. 12(2), 87-90 (2001).
  3. Jannati, P., Aref, S., Jannati, A. A., Jannati, F., & Moravvej, H. Comparison of therapeutic response of keloids to cryotherapy plus intralesional triamcinolone acetonide or verapamil hydrochloride. Journal of Skin and Stem Cell, 2(1) (2015).
  4. Zouboulis CC, Zouridaki E. Cryosurgery as a Single Agent and in Combination with Intralesional Corticosteroids Is Effective on Young, Small Keloids and Induces Characteristic Histological and Immunohistological Changes: A Prospective Randomized Trial. Dermatology. 237(3), 396-06 (2021).

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