Table 2.
Cryotherapy
| First author, year | Study design | Treatment | Duration | N | Outcome(s) | Follow-up time | Adverse events | Comments |
|---|---|---|---|---|---|---|---|---|
| Abdel-Meguid, 2015 [44] | P, RCT | Contact vs IL cryosurgery | Q3-4wks until flattening or max 6 sessions | 35 vs 31 | 48.5% vs 83.9% complete flattening (p < 0.05) | 3 months after final treatment | Pain, blistering, hypopigmentation | |
| Azzam, 2018 [43] | P | Excision + PRP + cryosurgery | Once | 50 |
70% had height reduction (p < .05). 72% had improved scar pliability (p < .05) 6 of 37 (16.21%) recurred |
12 months | Pain (44%), hypoesthesia (16%) |
Auricular keloids only Vancouver Scar Scale (VSS) |
| Barara, 2012 [39] | P | Cryosurgery | q4weeks until 6 sessions or 75% flattening | 30 | Mean flattening 58.13% flattening after 6 sessions | 6 months | Pain, dyspigmentation | |
| Bijlard, 2013 [45] | MC RCT | IL cryotherapy vs excision + IL TAC or excision + RT | Repeat at 3 months vs IL TAC at 2, 8, 12 weeks; vs 1 day RT | NA | NA | 52 weeks | Not stated | Study protocol |
| Bijlard, 2018 [46] | MC RCT | IL cryotherapy vs excision + IL TAC; IL cryotherapy vs excision + RT | Repeat at 3 months vs IL TAC at 2, 8, 12 weeks or 1 day RT | 26 | No difference in primary keloids: IL cryo vs excision + IL TAC; excision + RT in resistant keloid improved appearance (POSAS) and symptoms, but IL cryotherapy did not | 52 weeks | Terminated prematurely | |
| Careta, 2013 [42] | P | Shave removal, cryosurgery, and IL TAC | IL TAC at 30 days | 12 (13 keloids) | 80% thickness reduction in 75% of patients, 1 recurrence | Mean 12 months | Not stated | Earlobe keloids |
| Fraccalvieri, 2016 [41] | P | Shave removal + cryosurgery vs only cryosurgery | once | 153 | 94% complete smoothing (shave + cryo) vs 83% had 75–82% decrease in height (cryo) | 12–72 months | Dyschromia, dystrophic scars | Groups were not compared |
| Jannati, 2015 [40] | RCT |
Group 1: IL TAC+ cryotherapy Group 2: IL verapamil + cryotherapy Group 3: IL verapamil Group 4: cryotherapy |
q3wks until flattening or 6 months | 80 | All groups with significant improvement in all VSS variables | 1 year |
Group 1: telangiectasia, atrophy, dyspigmentation, menses problems Group 4: dyspigmentation, bullae |
|
| Mourad 2016 [47] | RCT | Spray versus IL cryotherapy | Q2wks for 10 sessions vs 6 sessions | 50 | Clinical improvement very good for 72% versus 96% (p = 0.02) | 6 months after last session | Pain, blistering, infection, delayed wound healing, hypopigmentation | |
| Patni, 2017 [48] | P | IL cryotherapy | Repeat at 8–and 16weeks prn | 15 (20 keloids) | POSAS with significant improvement; 50% with scar surface reduction of about 92% | 1 year | Pain, erythema, bulla, hypopigmentation | |
| Van Leeuwen, 2014 [49] | P | Intralesional cryotherapy with argon gas | 25 (30 keloids) | Volume reduction of 62%, POSAS improved 32%, 17% recurrence | 1 year | Pain, blistering, wound dehiscence, hypopigmentation |
P prospective trial, MC multicenter, SB single-blind, RCT randomized controlled trial, IL intralesional, TAC triamcinolone acetonide, PRP platelet-rich plasma