Keloids are a type of raised scar that grows beyond the boundaries of the original skin injury. They are benign (noncancerous) skin growths that may appear after an injury, burn, surgery, acne, or body piercings. Keloids can range in size from very small to quite large. While they are not dangerous, keloids can be disfiguring and may cause itching, pain, and tenderness.
Freezing keloids with cryotherapy is one treatment option that dermatologists may use to help flatten and shrink these scars. Cryotherapy uses extreme cold to damage or kill abnormal skin cells. Liquid nitrogen is the most common freezing agent used for cryotherapy on keloids.
How does freezing keloids work?
Freezing with liquid nitrogen works by causing a localized injury to the keloid scar. The extreme cold of the liquid nitrogen essentially burns the skin cells, causing them to die off. This destroys part of the scar tissue.
When the frozen skin cells die, the body’s immune system clears away the dead cells and scar tissue. As the injury from the freezing heals, new collagen forms to help repair the skin. However, there is less scar tissue overall after cryotherapy. This helps flatten and reduce the keloid.
The freezing process
During cryotherapy, the dermatologist will apply liquid nitrogen to the surface of the keloid using a cotton swab or spray device. The liquid nitrogen may be applied either by spraying it directly on the keloid or by applying it to the cotton swab and then touching the swab to the scar.
The liquid nitrogen is allowed to freeze the scar tissue for around 10-30 seconds. Two or more freezing sessions may be done during the appointment, with a rest time in between to allow the skin to thaw.
The treated area often turns red and swollen after freezing. Blisters may form. The skin will take several days to heal from the controlled damage caused by the liquid nitrogen.
Does freezing keloids hurt?
Many patients report that cryotherapy for keloids is not particularly painful. They may feel intense cold, stinging, and a burning sensation when the liquid nitrogen is applied. This discomfort usually subsides within a minute or so.
Your dermatologist can take steps to maximize comfort and minimize pain during the procedure. These may include:
- Applying a topical anesthetic to numb the skin before freezing
- Using a spray device rather than direct application to minimize freezing time
- Cooling the skin between freezing sessions
- Prescribing a pain reliever before or after the procedure
Tell your dermatologist about any pain or discomfort during the freezing sessions so they can adjust the treatment as needed.
What happens after freezing a keloid?
The skin will be irritated and swollen for a few days after cryotherapy. Proper wound care can help minimize discomfort during the healing process.
Your dermatologist may recommend:
- Applying antibiotic ointment to prevent infection as the skin heals
- Taking over-the-counter pain medication as needed for soreness
- Keeping the area moist with ointment and covered with a bandage
- Avoiding sun exposure until healed
The dead skin cells will slough off over the course of about one week. After several weeks, the skin will be healed and the keloid will be flatter.
You may notice the keloid turns darker after cryotherapy. This hyperpigmentation usually fades over time.
Results of cryotherapy
It often takes several cryotherapy sessions to achieve desired results. Treatments are typically spaced 3-6 weeks apart. Most people undergo 3-6 treatments.
Results of keloid freezing include:
- The keloid shrinks and becomes flatter
- Itching, irritation, and pain decreases
- The keloid may lighten in color
- Skin texture improves
While cryotherapy can help minimize keloids, there is a chance they may return over time. Using compression or silicone gel sheeting after treatment may help prolong results.
How effective is cryotherapy for keloids?
Cryotherapy is considered one of the more effective treatment options for shrinking keloids. However, it does not completely remove keloids. Research shows:
- 50-70% of keloids shrink by 50% or more with freezing
- Recurrence rates may be around 50% over 3-5 years
- Cryotherapy may be more effective on smaller keloids
- Multiple freeze-thaw cycles increase efficacy
Results can vary greatly depending on the individual, as well as keloid size, location, and thickness. Your doctor can discuss expected outcomes based on your specific case.
What are the risks or side effects?
Cryotherapy is considered very safe when performed correctly by a dermatologist. However, as with any procedure, some risks and side effects may occur.
Potential risks and side effects include:
- Pain and numbness during freezing, lasting for several minutes
- Redness, swelling, and blistering, lasting up to 1-2 weeks
- Infection if wound care is inadequate
- Changes in skin pigmentation, often temporary
- Damage to healthy skin around the keloid if freezing spreads
- Recurrence of the original keloid
- Formation of a new keloid scar from the cryotherapy
Serious risks like infection, necrosis, and permanent pigment changes are uncommon with proper treatment. Discuss your medical history thoroughly with your dermatologist before undergoing cryotherapy.
Who should not have cryotherapy for keloids?
Cryotherapy is not recommended for certain patients, including:
- Those with circulation disorders like Raynaud’s syndrome
- People with impaired immune systems
- Those with active skin infections
- Individuals who form keloids easily from minor injuries
- Pregnant or breastfeeding women
- People with pacemakers or defibrillators
Discuss your full medical history with your dermatologist so they can determine if you are a good candidate for keloid freezing.
How much does it cost to freeze off keloids?
The average cost for keloid cryotherapy ranges from $200 to $800 per session. Factors affecting the costs include:
- Geographic location – Prices are higher in major metro areas
- The dermatologist’s experience and expertise
- Size of the keloid being treated
- Number of sessions needed
- Whether insurance covers any of the costs
Many insurance plans do not cover keloid treatments since they are considered cosmetic. Check with your insurance about coverage details.
When are keloids frozen off?
The timing for freezing off keloids depends on several factors:
- Age of the keloid – Newer keloids tend to respond better.
- Stage of development – Treating immature keloids may prevent them from getting larger.
- Symptoms – Freezing may be used to reduce pain, itching, inflammation.
- Location – Keloids on the shoulders, earlobes, and sternum are common sites.
- Failure of other treatments – Cryotherapy is often tried when other options haven’t worked.
In general, many dermatologists recommend early treatment of keloids for the best results. Waiting too long may make them harder to eradicate. Discuss the optimal timing with your doctor.
Can keloids be frozen off at home?
It is not recommended to try freezing off keloids at home. Cryotherapy requires specialized equipment and training to perform safely and properly. Liquid nitrogen can cause severe injuries if used incorrectly.
Attempting do-it-yourself keloid removal could lead to:
- Freezing too deep and causing nerve damage
- Developing frostbite and open wounds
- Scarring healthy skin around the keloid
- Not freezing the entire keloid, allowing it to return
- Increasing the risk the keloid will grow back even larger
Leave keloid cryotherapy to a medical professional. This helps ensure the best results and minimizes the risk of complications or permanent injury.
Are there alternatives to freezing keloids?
Yes, cryotherapy is just one of several possible treatment options for shrinking keloids. Alternatives may include:
- Corticosteroid injections – Reduces inflammation and scar tissue growth
- Laser therapy – Burns away scar tissue with precision
- Radiation – Helps prevent recurrence of keloids
- Surgery – Cuts out the keloid, often with other techniques to prevent re-growth
- Silicone gel sheeting – Flattens and softens keloids
- Compression therapy – Helps flatten and prevent recurrence of keloids
Your doctor can help determine which treatment, or combination of treatments, may be most effective in your unique case.
What’s the best way to care for skin after freezing keloids?
Proper at-home care after cryotherapy can promote healing and help minimize side effects like infection and scarring.
Recommended aftercare tips include:
- Cleanse the area gently with mild soap and water 1-2 times per day
- Apply antibiotic ointment 2-3 times per day
- Cover with a sterile bandage or dressing
- Take over-the-counter pain medication as directed
- Avoid picking at scabs or crusts
- Use sun protection until fully healed
- Follow any other instructions from your dermatologist
Follow up with your dermatologist as directed so they can monitor your progress between treatments.
Conclusion
Cryotherapy is an effective treatment for shrinking and flattening keloid scars. Liquid nitrogen is used to freeze the scar tissue, causing localized injury. As the skin heals from the controlled damage, the keloid shrinks and becomes less noticeable.
Multiple freezing sessions are usually needed to achieve desired results. Some pain and side effects are common with cryotherapy but are temporary. While keloid recurrence is possible, freezing helps minimize the scar with minimal risks when performed properly.
Consult a dermatologist skilled in cryotherapy to determine if freezing is the right keloid treatment option for your scar.