How Does Cryotherapy Remove Keloids?

Cryotherapy is widely known as the treatment of exposing the body to subzero temperatures. It is mainly used to promote athletic and cosmetic health. By subjecting the body to extremely cold temperatures—anywhere from –200°F to -300°F— cryotherapy promotes natural anti-inflammatory response, the release of endorphins, and the reduction of pain and spasms. But cryotherapy also boasts another incredible benefit: the removal of keloids.

What are Keloids?

Keloids are benign growths that come about from excessive collagen formation. They are scar tissue that forms into firm, rubbery lesions. They occur when skin is injured and scar tissue forms to protect the injury. This scar tissue can turn into a hard and fibrous overgrowth––and that is a keloid.

Though they can affect all parts of the body, keloids are most often found on the chest, shoulders, cheeks, and earlobes. They can be itchy and uncomfortably tender against clothing or other friction, but generally people’s primary concern with keloids is a cosmetic one. They can result from a myriad of different skin injuries, including acne scars, burns, chickenpox scars, scratches, surgical or vaccination site incisions, or even from an ear piercing. An estimated 10% of people suffer from keloid scarring, and those of Asian or Latino descent, those pregnant, and those younger than thirty tend to be most prone.

While not typically harmful to one’s health, keloids can often be unsightly and many people wish to have them removed. The problem is that the standard keloid removal method (intralesional corticosteroid injection) has a high rate of keloid reappearance. That is where cryotherapy comes in. Cryotherapy, in the form of standard whole body, localized, or intralesional cryosurgery, has been shown to be the most effective, safest, and easiest-to-perform method of keloid removal. Also known as cryosurgery, the procedure involves the application of extreme cold to the keloid, often via liquid nitrogen.

Cryosurgical Removal of Keloids

The most common form of keloid removal vis-a-vis cryotherapy is the direct application of liquid nitrogen to the keloid. Liquid nitrogen is nitrogen that, under extreme pressure, becomes liquid. Upon evaporation, it produces extremely cold temperatures of up to -196 Celsius. Liquid nitrogen is used to freeze the keloid tissue, and has been found to be the most effective keloid treatment. 

As mentioned above, liquid nitrogen can be administered in a number of ways. There is whole-body cryotherapy, in which all but the head is submerged in a chamber cooled by liquid nitrogen. In localized or contact cryotherapy a selected bodily spot is sprayed with a concentrated mist of liquid nitrogen, and intralesional cryosurgery, a sterile cryoprobe is inserted through the middle of the scar, in order to produce rapid scar freezing for the core outwards. All methods have been shown to be effective, though contact cryotherapy is the most popular method, and intralesional cryotherapy is the newest. 

How Does the Cryotherapy Work for Keloids

What happens in the keloid removal process? According to Dr. Michael Tirgan, a physician who has treated over 1,500 keloid patients and who utilizes both the contact and intralesional cryotherapy, the liquid nitrogen treated keloid often swells into a large blister that can be double the size of the keloid. Over the 5-7 days after treatment, the treated keloid will ooze a yellowish, blood-tinged fluid, though the amount of leakage depends on the size of the keloid. 

Then, the keloid tissue begins to dry out, forming a dark-colored scab. Over the next few weeks, the scab will further darken in color before gradually contracting and reducing in size. When the scab falls off, the keloid will be smaller than previously, though it often takes two to three cryotherapy treatments to fully remove the keloid. The skin where the keloid previously was will appear pink and without pigmentation, though skin will normalize over time. This process can often be uncomfortable, especially for the first 1-2 hours after treatment, though some discomfort may linger for the next 8-12 hours. As pain tolerance varies from person to person, pain can be treated with a local anesthetic or simply painkillers like acetaminophen. 

Research on Cryosurgical Removal of Keloids

Maybe you’re wondering if any of the above backed by scientific research? The answer is: yes! A 2013 study of intralesional cryosurgery found that the method reduces the size of keloid scars and eliminates symptoms associated with abnormal scar formation. The researchers called cryosurgery a “novel, safe, and highly efficacious technique recommended for clinicians and patients striving to minimize both the appearance and discomfort of these physically and psychologically damaging lesions.” Additionally, the researchers found intralesional cryosurgery to be more effective than intralesional corticosteroid injection, the most widely used treatment method, which had as high as a 50% recurrence rate. The researchers recommended intralesional cryosurgery to be used in conjunction with local cryotherapy.

Another study also found cryosurgery to be effective in the treatment of keloids, particularly the types of smaller keloids that develop on the earlobes. The average flattening noted after three cryotherapy sessions was 30.76% and 58.13% after six sessions. The researchers concluded that cryotherapy “seems to be an effective treatment modality for keloids of recent onset, particularly smaller lesion.”

A third study utilizing contact cryotherapy found complete flattening of keloids to be achieved in 73% of scars. Even better, the study found no recurrence follow-ups in trial-goers ranging from 17 to 42 months. This led the researchers to conclude that “[c]ryotherapy is an effective, low-risk approach to keloid treatment associated with a low rate of recurrence. 

Along with the well-documented boosts to athletic performance and promotion of cosmetic wellness, keloid removal is another amazing benefit accorded by cryotherapy. Keloids can be unsightly and do serious damage to a person’s self-esteem. Cryotherapy, however, presents a great option for those seeking to eliminate keloids once and for all.