Erbium:YAG laser augments the penetration of cryotherapy


Cryotherapy is commonly used during dermatologic practice. Several modifications such as an “add-on” to topicals or intralesional applications have been already defined to enhance efficacy. The aim of this study is to test our hypothesis that ablative laser application before cryotherapy would increase the depth of freezing.Throughout this experiment, target points received either cryotherapy alone or a combination of erbium:yttrium-aluminum garnet (erbium:YAG) laser and cryotherapy. Freezing durations of 10 (C10), 20 (C20), and 30 seconds (C30) were investigated. Erbium:YAG laser groups received equal high energy shots with different pulse durations (100 μs versus 1500 μs) before freezing. The treatment points were arranged on the peripheral side of porcine skin specimens, and dermoscopic images revealing the iceball visible from the lateral side were immediately captured. Repeated experimental results were compared by Wilcoxon’s test. The comparison of the vertical length of the iceball between the three different freezing durations of 10 seconds, 20 seconds, and 30 seconds was statistically significant (p<0.05). The vertical length of the iceball was higher in both laser groups receiving 30-second freezing (mean ± SD: 4.32±0.53, 3.9±0.38 for micro-short pulse (MSP) and extra-long pulse (XLP), respectively) when compared with 30-second freezing alone (mean ± SD:3.51±0.44) (p=0.016). The two laser settings did not reveal a difference for the penetration of 30-second freezing (p=0.122). In this study, through visual monitorization of the iceball, erbium:YAG laser is found to augment the penetration of cryotherapy. The defined combination regimen has the potential to ameliorate treatment outcomes of cryotherapy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Cohen JK (2004) Cryosurgery of the prostate: techniques and indications. Rev Urol 6(Suppl 4):S20–S26

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Gill IS, Remer EM, Hasan WA, Strzempkowski B, Spaliviero M, Steinberg AP et al (2005) Renal cryoablation: outcome at 3 years. J Urol 173(6):1903–1907

    Article  Google Scholar 

  3. 3.

    Seifert JK, Junginger T (2004) Cryotherapy for liver tumors: current status, perspectives, clinical results, and review of literature. Technol Cancer Res Treat 3(2):151–163

    CAS  Article  Google Scholar 

  4. 4.

    Kumari C, Kumar A, Sarangi SK, Thirugnanam A (2019) Effect of adjuvant on cutaneous cryotherapy. Heat Mass Transf 55(2):247–260

    CAS  Article  Google Scholar 

  5. 5.

    Gupta S, Yadav S, Patra S, Gupta S (2017) Fractionated cryotherapy. J Am Acad Dermatol 77(3):e69–e71

    Article  Google Scholar 

  6. 6.

    Zeitouni NC, Shieh S, Oseroff AR (2001) Laser and photodynamic therapy in the management of cutaneous malignancies. Clin Dermatol 19(3):328–338

    CAS  Article  Google Scholar 

  7. 7.

    Mercuri SR, Brianti P, Dattola A, Bennardo L, Silvestri M, Schipani G et al (2018) CO2 laser and photodynamic therapy: study of efficacy in periocular BCC. Dermatol Ther 31(4):e12616

    Article  Google Scholar 

  8. 8.

    Zaleski-Larsen LA, Fabi SG (2016) Laser-Assisted Drug Delivery. Dermatol Surg 42(8):919–931

    CAS  Article  Google Scholar 

  9. 9.

    Janik JP, Markus JL, Al-Dujaili Z, Markus RF (eds) (2007) Laser resurfacing. Seminars in plastic surgery. Thieme Medical Publishers

  10. 10.

    Kao B, Kelly KM, Aguilar G, Hosaka Y, Barr RJ, Nelson JS (2004) Evaluation of cryogen spray cooling exposure on in vitro model human skin. Lasers Surg Med 34(2):146–154

    Article  Google Scholar 

  11. 11.

    Majaron B, Kelly KM, Park HB, Verkruysse W, Nelson JS (2001) Er: YAG laser skin resurfacing using repetitive long-pulse exposure and cryogen spray cooling: I. Histological study. Lasers Surg Med 28(2):121–130

    CAS  Article  Google Scholar 

  12. 12.

    Zhang R, Ramirez-San-Juan JC, Choi B, Jia W, Aguilar G, Kelly KM et al (2006) Thermal responses of ex vivo human skin during multiple cryogen spurts and 1,450 nm laser pulses. Lasers Surg Med 38(2):137–141

    Article  Google Scholar 

  13. 13.

    Lee YI, Kim J, Yang CE, Hong JW, Lee WJ, Lee JH (2019) Combined therapeutic strategies for keloid treatment. Dermatol Surg 45(6):802–810

    CAS  Article  Google Scholar 

  14. 14.

    Jiao A, Liu F, Lerner AD, Rao X, Guo Y, Meng C et al (2019) Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy. Pediatr Investig 3(1):9–16

    Article  Google Scholar 

  15. 15.

    Lee H, Jeong Y-U, Chan KF (2009) The advent of laser therapies in dermatology and urology: underlying mechanisms, recent trends and future directions. J Opt Soc Korea 13(3):321–329

    CAS  Article  Google Scholar 

  16. 16.

    (1994) Guidelines of care for cryosurgery. American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol 31(4):648–653

  17. 17.

    Andrews MD (2004) Cryosurgery for common skin conditions. Am Fam Physician 69(10):2365–2372

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Aysenur Botsali.

Ethics declarations

Ethics approval and consent to participate


Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Botsali, A., Beksac, B., Gahramanov, İ. et al. Erbium:YAG laser augments the penetration of cryotherapy. Lasers Med Sci (2021).

Download citation


  • Erbium
  • YAG laser
  • Ablative laser
  • Cryosurgery
  • Cryotherapy
  • Skin cancer