Can intralesional cryotherapy reshape the management of difficult keloid scars?

Abstract

Keloid scars are notoriously difficult to treat with very high recurrence rates despite a range of treatment options. We present a case report of a 43-year-old man with a resistant keloid scar on his left ear from a piercing. After 15 years of multimodal treatments including surgery, steroid and 5-fluorourcil injections, the keloid persisted. It has responded very well to a single treatment of intralesional cryotherapy (trademark: CryoShape, Etgar Group International Ltd). The authors would now consider intralesional cryotherapy as a useful tool in their armamentarium for prominent, resistant or recurrent keloids. Future experience will guide its clinical applications.Lay SummaryThere is limited evidence of efficacy, more research is required.Background: Keloid scars grow outside of the initial wound margins. They can be itchy and very unsightly. They are difficult to treat. Whether treated by surgical removal, injections, or radiotherapy, there is a high recurrence rate.Question: Can a new technique be used to successfully treat resistant keloid scars?How the work was conducted: A technique of freezing the scar to cause frostbite and auto-amputation of the scar has been developed. This report describes 15 years of multi-modality treatment for a patient who had a large keloid scar on his ear. It recurred after all conventional treatments and had started growing very aggressively despite treatments. A new technique of intralesional cryotherapy was used to freeze the keloid scar. This has had excellent initial results and although the follow-up time is relatively short at six months, there has been no aggressive regrowth yet which is very promising.What have we learnt: The procedure went smoothly and was very well-tolerated by the patient. The scar resolved with no early evidence of recurrence. We do not yet know whether this scar will recur in the future and if so how quickly. The scar was however very troublesome to the patient before the treatment and his symptoms have now resolved with no sign of regrowth to date. We need a larger case series with long term follow up before any firm conclusions can be drawn from this.