Cryotherapy in Treatment of Keloids:

1
Evaluation of Factors
Affecting Treatment Outcome
JOURNAL READING

Pembimbing:
dr. Resati Nando Panonsih, M.Sc. Sp.KK

by:
Shilvia Adita Putri
17360073
 Introduction
2

Keloids are benign fibrous growths that

occur after trauma or wounding of skin.
Keloidal scars typically extend beyond the
original wound and spread by invasion
rather than expansion.
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radiotherapy Silicon gel

plastic
surgery topical therapy (eg. heparin,
allantoin, Vitamin A
acids,Vitamin E, imiquimod),
laser therapy
Physical therapy :
ultrasonography,
cryosurgery iontophoresis

Treatment
intralesional modalities Systemic therapy :
steroids have been pentoxyphyline
tried
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The present study to analyse the effect of

cryotherapy in keloids and to relate the
treatment outcome with the clinico-
aetiological factors.
 Materials and Methods
5

A hospital-based interventional study was

conducted comprising of 30 patients → 12 male
and 18 female
Inclusion Exclusion

more than 12 Patient with

years of age, with contraindications For
untreated keloids cryotherapy

Patients who had

taken treatment for
keloids in past 12
weeks
 Methods
6

Assessment was made one month after 3 treatment

sessions and a month after treatment completion.
The parameters assessed :

Recording
using serial
symptomatic photography
improvement
firmness of
keloids

size of keloids
 Cont….
7

To evaluate the treatment outcome, improvement

was graded as:
 Poor: No improvement/<25% flattening
 Average: 25- 49% flattening
 Good: 50-74% flattening
 Excellent: >75% flattening
 Cont…
8

Patient satisfaction scale was used to evaluate the

treatment outcome at completion of six treatment
sessions:
 0: Static/no improvement

 1: Slight improvement

 2: Marked improvement

 3: Excellent improvement/complete flattening

 Result & Discussion
9

6%
pain

36%
pruritus
58%
cosmetic
botheration
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effect of duration on
treatment outcome, 3
groups:
Group A: ≤3 years;
Group B: 3-6 years;
Group C: ≥6 years.

Recent onset keloids had an early response with maximum flattening obtained
in first 3 months. In contrast, older keloids with duration more than 3 years
showed an initial slow response with maximum flattening being observed
in the latter half of therapy
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Effect of thickness on treatment outcome, keloids 3 :

 Group A : thickness ≤ 0.3 cm; (11 patients)
 Group B: thickness 0.3-0.6 cm; (14 patients)
 Group C: thickness ≥ 0.6 cm; (5 patient)

There was an insignificant negative correlation (P value =

0.253) between percentage flattening at 3 months with
baseline thickness. there was a significant negative correlation
between percentage flattening at 6 months with base-line
thickness (P value = 0.023). Thus suggesting, that thickness had
an effect on percentage flattening at 6 months but not after 3
treatment sessions.
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 Anatomical site of keloids and etiology did not

have any significant correlation with treatment
outcome, either at 3 or at 6 months.
 Patient satisfaction scale :

 73.3% patients graded the improvement as good

to excellent (scale of 0-3),

 23.3% patients as moderate (scale = 1),

 only 3.3% patients scored the improvement as 0

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 8 patients had severe pain during treatment,

remaining patients had mild to moderate pain.
However, the pain was relieved to tolerable level in
all patients within 1 hour of therapy. Intralesional
cryotherapy seems to be a useful option to prevent
this side effect.
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it was observed that there was significantly more

flattening in younger lesions noted after 3 and 6
treatment sessions
 Conclusions
17

 Cryotherapy seems to be an effective treatment

modality for keloids of recent onset, particularly
smaller lesions. Duration and thickness of the keloids
were found to be the most important factors in
determining treatment outcome with cryotherapy in
our study. Larger studies are, however, required to
confirm the efficacy of this treatment modality and
to validate our findings of the factors affecting
treatment outcome.
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Thank you……