Cryotherapy

The charts below show the chances of developing various side effects from cryotherapy. For some side effects, we currently do not have enough data to provide a percentage. Because intralesional cryotherapy has become the standard of treatment in cryotherapy, most of the studies which have looked at the side effects of cryotherapy have focused on intralesional cryotherapy.3-7

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Mild to moderate post-operative painup to 100%
SHORT TERM Post-operative crustingup to 100%
SHORT TERM Post-operative blisteringup to 100%
SHORT TERM Transient skin lightening (hypopigmentation)up to 100%
LONG TERM Residual skin lightening (hypopigmentation)*31% to 75%
SHORT TERM Superficial surface skin death (necrosis)up to 40%
SHORT TERM Swellingincidence not known

*Residual skin lightening (hypopigmentation): Most patients experience some hypopigmentation (lightening) of the treated skin after cryotherapy, but in some patients, this condition can persist for a year or longer, and in some cases, the skin never regains its color.4,5

Possible/Rare Side Effects

SHORT TERM Wound infectionup to 7.5%
SHORT TERM or LONG TERM Atrophic (indented) scarsup to 7.4%

Studies:   

Four studies have looked at the side effects of cryotherapy.

  • Study 1:

    • Authors: Rusciani et al.4
    • Total # of patients: 135
    • # of female patients: 92
    • # of male patients: 43
    • Age of patients: 5-67
    • Treatment type: Contact cryotherapy
    • Duration of treatment and follow-up: 1-5 treatments, follow-up for up to 72.6 months (medium follow-up for 48.6 months)
    • Side effects:

      • Residual hypopigmentation (skin lightening): 75%
      • Atrophic (indented) scars: 7.4%
  • Study 2:

    • Authors: van Leeuwen et al.5
    • Total # of patients: 27
    • # of female patients: 19
    • # of male patients: 8
    • Age of patients: 12-71 average: 31.7
    • Treatment type: Intralesional cryotherapy
    • Duration of treatment and follow-up: 1-2 sessions, follow-up at 12 months
    • Side effects:

      • Mild to moderate post-operative pain: 100%
      • Post-operative crusting: 100%
      • Post-operative blistering: 100%
      • Wound infection: 7.5%
      • Persisting hypopigmentation (skin lightening) lasting 12 months or longer: 31%
  • Study 3:

    • Authors: Zouboulis et al.7
    • Total # of patients: 10
    • # of female patients: 5
    • # of male patients: 5
    • Age of patients: 22-62 Average: 31
    • Treatment type: Intralesional cryotherapy
    • Duration of treatment and follow-up: 3-6 sessions, follow-up for 6 months
    • Side effects:

      • Superficial necrosis (skin death): 40%
      • Hypopigmentation (skin lightening): 40%
  • Study 4:

    • Authors: Gupta and Kumar6
    • Total # of patients: 12
    • # of female patients: 3
    • # of male patients: 7
    • Age of patients: 19-50 Average: 31.25
    • Treatment type: Intralesional cryotherapy
    • Duration of treatment and follow-up: 5-10 sessions, follow-up for up to 12 months
    • Side effects:

      • Mild to moderate post-operative pain: 100%
      • Hypopigmentation (skin lightening): 1005

Study 1: In a study published in 2006 in the Journal of Drugs in Dermatology, Rusciani and colleagues performed contact cryotherapy on 135 patients who had a total of 166 keloids. The patients received 1-5 sessions of treatment depending on how much scars improved after each session. Sessions were administered at 1-month intervals, and the researchers followed up with the patients for an average of 48.6 months, but in some cases up to 72.6 months. The most common side effect was hypopigmentation (skin lightening), which never improved during the entire follow-up period.4

Study 2: In a study published in 2015 in the journal Plastic and Reconstructive Surgery, van Leeuwen and colleagues treated 27 patients with keloid scars with intralesional cryotherapy. The majority (69%) of patients received 1 treatment session, but some (31%) received 2 sessions with a 6-mont interval. All patients were followed-up for 1 year after treatment. All patients experienced pain after the procedure, and all developed crusts and blisters, which lasted up to 3 weeks. Some patients were prescribed antibiotics because the wound became infected. Some patients developed hypopigmentation (skin lightening) which did not disappear during the 1-year follow-up period.5

Study 3: In a study published in 2004 in the journal Archives of Dermatology, Zouboulis and colleagues treated 10 patients with keloids with intralesional cryotherapy. The patients had been suffering from recalcitrant (resistant to treatment) keloids for 1-10 years. Each patient received 3-6 sessions of treatment at 1-month intervals and was followed up for 6 months after the last treatment. Side effects included superficial necrosis (skin death) and hypopigmentation (skin lightening).7

Study 4: In a study published in 2001 in the International Journal of Dermatology, Gupta and Kumar treated 12 patients with large keloids with intralesional cryotherapy. The patients received 5-10 treatment sessions at intervals of 3-4 weeks and were followed up for up to 12 months. All patients experienced pain after treatment and developed hypopigmentation (skin lightening), also known as depigmentation, along the tracks of the cryosurgery needles. However, during the follow-up period, pigment spread from the surrounding skin to the lightened skin, causing the lightened areas to decrease in size.6 

References
  1. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  2. van Leeuwen MC, et al. Intralesional cryotherapy for the treatment of keloid scars: evaluating effectiveness. Plastic and Reconstructive Surgery Global Open. 3(6), (2015).
  3. Ledon JA, Savas J, Franca K, Chacon A, and Nouri K. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatologic Surgery. 39(12), 1745-57 (2013).
  4. Rusciani L, Paradisi A, Alfano C, Chiummariello S, and Rusciani A. Cryotherapy in the treatment of keloids. J Drugs Dermatol. 5(7), 591-5 (2006).
  5. van Leeuwen MC, et al. Intralesional cryotherapy for treatment of keloid scars: a prospective study. Plast Reconstr Surg. 135(2), 580-9 (2015).
  6. Gupta S, and Kumar B. Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids.  Int J Dermatol. 40(5), 349-53 (2001)
  7. Zouboulis CC, Rosenberger AD, Forster T, Beller G, Kratzsch M, and Felsenberg D. Modification of a device and its application for intralesional cryosurgery of old recalcitrant keloids. Arch Dermatol. 140(10), 1293-4 (2004).