Intralesional cryotherapy to treat exophytic keloids: the Universitas Hospital Bloemfontein experience
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The skin is composed of labile cells, which to some extent can regenerate, but in cases of deep and significant damage, healing occurs by secondary intention with subsequent scar formation. Keloids are wound scars that grow beyond the original wound site and are characterized by an overabundance of collagen at the injured site, in a craw like fashion that distinguish them from hypertrophic scars. They result from dermal injury, mostly from trauma, infection and burns, and at times, they occur spontaneously. Keloids commonly occur on the earlobes, back, shoulders and chest and can be a major source of embarrassment and anxiety. These scars can also be painful and itchy. The prevalence of keloids is higher among patients with darker skin especially in Africans and Asians. Treatment options for these scars vary, however, a high recurrence rate after such treatments have been reported. Some modalities have sporadically yielded better outcomes, more so when used in combinations. It is therefore important to find a treatment that is safe, non-toxic and with reduced chances of recurrence in affected individuals. Intralesional cryotherapy is a treatment for keloid scars in which liquid Nitrogen is used to freeze the scar from inside. This study therefore sought to treat exophytic keloids with intralesional liquid Nitrogen (Cryotherapy) as a deep-freeze from the core of the keloid under local anaesthetic. This adds a newer method of keloid management contributing towards standardizing exophytic keloid management. A prospective case series was conducted among twelve patients attending the Dermatology outpatient department, at Universitas Hospital in Bloemfontein from 1 August 2016 to 01 March 2017. These patients were seen at the initial visit, then at six weeks and six months respectively. All the subjects were Africans, with 7 (58.3%) being female and 5 (41.7%) male. A third of the patients (4) (33.3%) had more than one site of involvement. Significant reduction in the exophytic keloidal mass post deep-freezing, irrespective of the keloid area, duration, gender and cause was observed among these patients. Two-thirds of these patients were either satisfied or very satisfied with the clinical outcome of the scar at six months. The use of intralesional cryotherapy for exophytic keloids has potential to become the main modality of treatment in future. Our study had some limitations including a small sample size, relatively high rate of patients lost to follow up (33.3%) and some unanticipated technical difficulties.