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Cryosurgery in the Treatment of Keloids and Hypertrophic Scars

  • Chapter
Basics of Cryosurgery

Abstract

Cryosurgery — the well aimed and controlled destruction of diseased tissue by application of cold — is an effective and efficient method for treating various skin diseases (Graham 1993; Kuflik 1994; Zacarian 1994; Zouboulis 1998, 1999). The technique has several advantages and, especially in the treatment of keloids and hypertrophic scars, it provides good therapeutic and cosmetic results with few contraindications and a low incidence of complications (Zouboulis et al. 1993a; Rusciani et al. 1993; Ernst and Hundeiker 1995). The therapeutic effects of freezing on tissues have also been successfully used in the treatment of superficial atrophic acne scars (Table 15.1; Graham 1985; Rohrs 1997).

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References

  1. Appleton I, Brown NJ, Willoughby DA. Apoptosis, necrosis, and proliferation: possible implications in the etiology of keloids. Am J Pathol 1996; 149: 1441–1447.

    PubMed  CAS  Google Scholar 

  2. Arakawa M, Hatamochi A, Mori Y, Mori K, Ueki H, Moriguchi T. Reduced collagenase gene expression in fibroblasts from hypertrophic scar tissue. Br J Dermatol 1996; 134: 863–868.

    Article  PubMed  CAS  Google Scholar 

  3. Banfalvi T, Boer A, Remenar E, Oberna F. Treatment of keloids (review of the literature, therapeutic suggestions). Orv Hetil 1996; 137: 1861–1864.

    PubMed  CAS  Google Scholar 

  4. Berman B, Bieley HC. Keloids. J Am Acad Dermatol 1995; 33: 117–123.

    Article  PubMed  CAS  Google Scholar 

  5. Breitbart EW, Schaeg G. Electron microscopic investigation of the cryolesion. In: Breitbart EW, Dachow-Siwiec E (eds) Clinics in dermatology: advances in cryosurgery. New York: Elsevier, 1990: 30–38.

    Google Scholar 

  6. Brown LA Jr, Pierce HE. Keloids: scar revision. J Dermatol Surg Oncol 1986; 12: 51–56.

    PubMed  Google Scholar 

  7. Ceilley RI, Babin RW. The combined use of cryosurgery and intralesional injections of suspensions of fluorinated adrenocorticosteroids for reducing keloids and hypertrophic scars. J Dermatol Surg Oncol 1979; 5: 54–56.

    PubMed  CAS  Google Scholar 

  8. Chiarello SE. Full-face cryo-(liquid nitrogen) peel. J Dermatol Surg Oncol 1992; 18: 329–332.

    PubMed  CAS  Google Scholar 

  9. Cirne de Castro JL, Pereira dos Santos A, Morais Cardoso LP, Ribeiro R. Cryosurgical treatment of a large keloid. J Dermatol Surg Oncol 1986; 12: 740–742.

    PubMed  CAS  Google Scholar 

  10. Dalkowski A. Immunhistochemische Untersuchungen an Keloiden und keloidalen Fibroblasten und der Einfluß der Kryotherapie auf Proliferation, synthetische Aktivität und Immunphänotyp humaner keloidaler und normaler Fibroblasten in vitro. Dissertation, The Free University of Berlin, Berlin, Germany, 1997.

    Google Scholar 

  11. Datubo-Brown DD. Keloids: a review of the literature. Br J Plast Surg 1990; 43: 70–77.

    Article  PubMed  CAS  Google Scholar 

  12. Dawber R. Cold kills! Clin Exp Dermatol 1988; 13: 137–150.

    Article  PubMed  CAS  Google Scholar 

  13. Diegelmann RF, Cohen IK, McCoy BJ. Growth kinetics and collagen synthesis of normal skin, normal scar and keloid fibroblasts in vitro. J Cell Physiol 1979; 98: 341–346.

    Article  PubMed  CAS  Google Scholar 

  14. Drake LA, Ceilley RI, Cornelison RL, Dobes WL, Dorner W, Goltz RW, Lewis CW, Salasche SJ, Chanco Turner ML, Lowery BJ, Graham GF, Detlefs RL, Garrett AB, Kuflik EG, Lubritz RR. Guidelines of care for cryosurgery. J Am Acad Dermatol 1994; 31: 648–653.

    Article  Google Scholar 

  15. Ehrlich HP, Hembry RM. A comparative study of fibroblasts in healing, freeze and burn injuries in rats. Am J Pathol 1984; 117: 218–224.

    PubMed  CAS  Google Scholar 

  16. Ehrlich HP, Desmouliere A, Diegelmann RF, Cohen IK, Compton CC, Garner WL, Kapanci Y, Gabbiani G. Morphological and immunochemical differences between keloid and hypertrophic scar. Am J Pathol 1994; 145: 105–113

    PubMed  CAS  Google Scholar 

  17. Elton RF. Epilogue. In: Zacarian SA (ed) Cryosurgery for skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985: 313–322.

    Google Scholar 

  18. Engrav LH, Gottlieb JR, Millard SP, Walkinshaw MD, Heimbach DM, Marvin JA. A comparison of intramarginal and extramarginal excision of hypertrophic burn scars. Plast Reconstr Surg 1988; 81: 40–45.

    Article  PubMed  CAS  Google Scholar 

  19. Ernst K, Hundeiker M. Ergebnisse der Kryochirurgie bei 394 Patienten mit hypertrophen Narben und Keloiden. Hautarzt 1995; 46: 462–466.

    Article  PubMed  CAS  Google Scholar 

  20. Farrant J, Walter CA. The cryobiological basis of cryosurgery. J Dermatol Surg Oncol 1977; 3: 403–407.

    PubMed  CAS  Google Scholar 

  21. Ferris DG, Ho JJ. Cryosurgical equipment: a critical review. J Fam Practice 1992; 35: 185–193.

    CAS  Google Scholar 

  22. Gage A, Meenaghan M, Natiella J, Greene G. Sensitivity of pigmented mucosa and skin to freezing injury. Cryobiology 1979; 16: 348–361.

    Article  PubMed  CAS  Google Scholar 

  23. Gage AA. Deep cryosurgery. In: Epstein E, Epstein E (eds) Skin Surgery. Springfield: Charles C Thomas, 1982: 857–877.

    Google Scholar 

  24. Gage AA, Caruana JA Jr, Montes M. Critical temperature for skin necrosis in experimental cryosurgery. Cryobiology 1982; 19: 273–282.

    Article  PubMed  CAS  Google Scholar 

  25. Glazer SF, Sher AM. Adjunctive cryosurgery in the surgical approach to keloids. In: Zacarian SA (ed) Cryosurgery for skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985: 91–95.

    Google Scholar 

  26. Graham G. Cryosurgery for acne. In: Zacarian SA (ed) Cryosurgery for skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985: 59–76.

    Google Scholar 

  27. Graham GF. Cryosurgery. Clin Plast Surg 1993; 20: 131–147.

    PubMed  CAS  Google Scholar 

  28. Hirshowitz B, Lerner D, Moscona AR. Treatment of keloid scars by combined cryosurgery and intralesional corticosteroids. Aesth Plast Surg 1982; 6: 153–158.

    Article  CAS  Google Scholar 

  29. Hunzelmann N, Anders S, Sollberg S, Schonherr E, Krieg T. Coordinate induction of collagen type I and biglycan expression in keloids. Br J Dermatol 1996; 135: 394–399.

    Article  PubMed  CAS  Google Scholar 

  30. James WD, Besaucenaey CD, Odom RB. The ultrastructure of a keloid. J Am Acad Dermatol 1980; 3: 50–57.

    Article  PubMed  CAS  Google Scholar 

  31. Juhlin L, Evers H, Broberg F. A lidocaine-prilocaine cream for superficial skin surgery and painful lesions. Acta Derm Venereol (Stockh) 1980; 60: 544–546.

    CAS  Google Scholar 

  32. Kelly AP. Keloids. Dermatol Clin 1988; 6: 413–424.

    PubMed  CAS  Google Scholar 

  33. Kuflik EG. Cryosurgery updated. J Am Acad Dermatol 1994; 31: 925–944.

    Article  PubMed  CAS  Google Scholar 

  34. Kulka JP. Cold injury of the skin. The pathogenic rate of microcirculatory impairment. Arch Environ Health 1965; 11: 484–497.

    PubMed  CAS  Google Scholar 

  35. Layton AM, Yip J, Cunliffe WJ. A comparison of intralesional triamcinolone and cryosurgery in the treatment of acne keloids. Br J Dermatol 1994; 130: 498–501.

    Article  PubMed  CAS  Google Scholar 

  36. Lee YS, Vijayasingam S. Mast cells and myofibroblasts in keloid: a light microscopic, immunohistochemical and ultrastructural study. Ann Acad Med Singapore 1995; 24: 902–905.

    PubMed  CAS  Google Scholar 

  37. Lubritz RR. Cryosurgical spray patterns. J Dermatol Surg Oncol 1978; 4: 138–139. Lubritz RR. Cryosurgical approach to benign and precancerous tumors of the skin. In: Zacarian SA (ed) Cryosurgery for skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985:41–58.

    PubMed  CAS  Google Scholar 

  38. Matsuoka LY, Uitto J, Wortsman J, Abergel P, Dietrich J. Ultrastructural characteristics of keloid fibroblasts. Am J Dermatopathol 1988; 10: 505–508.

    Article  PubMed  CAS  Google Scholar 

  39. Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol 1984; 247: 125–142.

    Google Scholar 

  40. Meltzer L. A cryoprobe for the therapy of linear keloid. J Dermatol Surg Oncol 1983; 9: 111–112.

    PubMed  CAS  Google Scholar 

  41. Mende B. Keloidbehandlung mittels Kryotherapie. Z Hautkr 1987; 62: 1348–1355.

    PubMed  CAS  Google Scholar 

  42. Muir IFK. On the nature of keloid and hypertrophic scars. Br J Plast Surg 1990; 43: 61–69.

    Article  PubMed  CAS  Google Scholar 

  43. Muti E, Ponzio E. Cryotherapy in the treatment of keloids. Ann Plast Surg 1983; 11: 227–232.

    Article  PubMed  CAS  Google Scholar 

  44. Nakaoka H, Miyauchi S, Miki Y. Proliferating activity of dermal fibroblasts in keloids and hypertrophic scars. Acta Derm Venereol (Stockh) 1995; 75: 102–104.

    CAS  Google Scholar 

  45. Orpwood RD. Biophysical and engineering aspects of cryosurgery. Phys Med Biol 1981; 26: 555–575.

    Article  PubMed  CAS  Google Scholar 

  46. Peacock EE Jr, Madden JM, Trier WC. Some studies on the treatment of keloids and hypertrophic scars. Southern Med J 1970; 63: 755–760.

    Article  PubMed  Google Scholar 

  47. Rabb JM, Renaud ML, Bradt PA, Witt CW. Effect of freezing and thawing on microcirculation and capillary endothelium of the hamster cheek pouch. Cryobiology 1974; 11: 508–518.

    Article  PubMed  CAS  Google Scholar 

  48. Rinfret AP. Cryobiology. In: Vance RW (ed) Cryogenic technology. New York: John Wiley & Sons, 1962.

    Google Scholar 

  49. Röhrs H. Dokumentation therapeutischer und kosmetischer Ergebnisse bei der kryochirurgischen Behandlung von Hauterkrankungen. Dissertation, The Free University of Berlin, Berlin, Germany, 1997.

    Google Scholar 

  50. Röhrs H, Orfanos CE, Zouboulis ChC. Cryosurgical treatment of acne keloids. J Invest Dermatol 1997; 108: 396.

    Google Scholar 

  51. Rudolph R. Wide spread scars, hypertrophic scars, and keloids. Clin Plast Surg 1987; 14: 253–260.

    PubMed  CAS  Google Scholar 

  52. Rusciani L, Rossi G, Bono R. Use of cryotherapy in the treatment of keloids. J Dermatol Surg Oncol 1993; 19: 529–534.

    PubMed  CAS  Google Scholar 

  53. Scott PG, Dodd CM, Tredget EE, Ghahary A, Rahemtulla F. Immunohistochemical localization of the proteoglycans decorin, biglycan and versican and transforming growth factor-beta in human post-burn hypertrophic and mature scars. Histopathology 1995; 26: 423–431.

    Article  PubMed  CAS  Google Scholar 

  54. Sebastian G, Scholz A. Unsere Erfahrungen mit konservativen Therapiemethoden bei hypertrophen Narben und Keloiden. Dt Derm 1990; 38: 872–877.

    Google Scholar 

  55. Sebastian G, Scholz A. Histopathology of the cryolesion. Dermatol Monatsschr 1993; 179: 237–241.

    Google Scholar 

  56. Shepherd JP. The effects of low temperature on dermal connective tissue components. Dissertation, University of Oxford, Oxford, United Kingdom 1979.

    Google Scholar 

  57. Shepherd JP, Dawber RPR. The response of keloid scars to cryosurgery. Plast Reconstr Surg 1982; 70: 677–681.

    Article  PubMed  CAS  Google Scholar 

  58. Simon CA. A simple and accurate cryosurgical tool for the treatment of benign skin lesions: The “hard tail” dip-stick. J Dermatol Surg Oncol 1986; 12: 680–682.

    PubMed  CAS  Google Scholar 

  59. Stern JC, Lucente FE. Carbon dioxide laser excision of earlobe keloids. A prospective study and critical analysis of existing data. Arch Otolaryngol Head Neck Surg 1989; 115: 1107–1111.

    Article  PubMed  CAS  Google Scholar 

  60. Torre D. Understanding the relationship between lateral spread of freeze and depth of freeze. J Dermatol Surg Oncol 1979; 5: 1–3.

    Google Scholar 

  61. Torre D. Instrumentation and monitoring devices in cryosurgery. In: Zacarian SA (ed) Cryosurgery for skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985: 31–40.

    Google Scholar 

  62. Weshahy AH. Intralesional cryosurgery. A new technique using cryoneedles. J Dermatol Surg Oncol 1993; 19: 123–126.

    PubMed  CAS  Google Scholar 

  63. Wulff A, Zouboulis ChC, Blume-Peytavi U, Schuppan D, Orfanos CE. Tenascin: Ein Marker für die Charakterisierung von Keloiden in vivo und von keloidalen Fibroblasten in vitro. In: Gollnick H, Blume U, Zouboulis ChC, eds. Abstracts of the 38th Meeting of the German Dermatological Society. Herford: Busse, 1995: 385.

    Google Scholar 

  64. Wulff A, Zouboulis ChC, Blume-Peytavi U, Sommer Ch, Schuppan D, Orfanos CE. Cryotherapy modifies proliferation and collagen synthesis of keloidal fibroblasts. Arch Dermatol Res 1996; 288: 303.

    Google Scholar 

  65. Younai S, Venters G, Vu S, Nichter L, Nimni ME, Tuan TL. Role of growth factors in scar contraction: an in vitro analysis. Ann Plast Surg 1996; 36: 495–501.

    Article  PubMed  CAS  Google Scholar 

  66. Zacarian SA, Stone D, Clater M. Effect of cryogenic temperature on the microcirculation of the golden Syrian hamster cheek pouch. Cryobiology 1970; 7: 22–29.

    Article  Google Scholar 

  67. Zacarian SA. Cryogenics: the cryolesion and the pathogenesis of cryonecrosis. In: Zacarian SA (ed) Cryosurgery of skin cancer and cutaneous disorders. St Louis: CV Mosby, 1985: 1–30.

    Google Scholar 

  68. Zacarian SA. Cryosurgery in the management of cutaneous disorders and malignant tumors of the skin. Compr Ther 1994; 20: 379–401.

    PubMed  CAS  Google Scholar 

  69. Zouboulis ChC, Orfanos CE. Kryochirurgische Behandlung von hypertrophen Narben und Keloiden. Hautarzt 1990; 41: 683–688.

    PubMed  CAS  Google Scholar 

  70. Zouboulis ChC, Blume U, Büttner P, Orfanos CE. Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series. Arch Dermatol 1993a; 129: 1146–1151.

    Article  CAS  Google Scholar 

  71. Zouboulis ChC, Blume U, Orfanos CE. Keloids and hypertrophic scars: cryosurgical treatment and postsurgical cryoprevention. Dermatol Monatsschr 1993b; 179: 278–284.

    Google Scholar 

  72. Zouboulis ChC, Zouridaki E, Wulff A. The treatment of keloids, hypertrophic and atrophic scars. J Eur Acad Dermatol Venereol 1996; 7(Suppl. 2): 22.

    Google Scholar 

  73. Zouboulis ChC. Cryosurgery in dermatology. Eur J Dermatol 1998;8: 466–474.

    PubMed  CAS  Google Scholar 

  74. Zouboulis ChC. Principles of cutaneous cryosurgery: An update. Dermatology 1999;198: 111–117.

    Article  PubMed  CAS  Google Scholar 

  75. Zouboulis ChC, Orfanos CE. Cryosurgical treatment. In: Hatahap M (ed) Surgical techniques for cutaneous scar revision. New York: Marcel Dekker, 2000: 171–234.

    Google Scholar 

  76. Zouridaki E, Trautmann Ch, Alvertis H, Katsambas A, Orfanos CE, Zouboulis ChC. Cryosurgery alone and cryosurgery combined with intralesional steroids are equally effective on keloids but induce different histological changes: results of a prospective randomised study. J Eur Acad Dermatol Venereol 1996; 7 (Suppl. 2): 87.

    Google Scholar 

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Zouboulis, C.C. (2001). Cryosurgery in the Treatment of Keloids and Hypertrophic Scars. In: Korpan, N.N. (eds) Basics of Cryosurgery. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6225-5_15

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  • DOI: https://doi.org/10.1007/978-3-7091-6225-5_15

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