Intralesional cryotherapy is beginning to emerge as an alternative to external cryotherapy. “The problem with freezing keloids with a traditional cryogun is that you freeze the surface of the lesion and not necessarily the inside of the lesion,” said Gary Goldenberg, MD, assistant professor of dermatology and pathology at the Mount Sinai School of Medicine in New York City. A new, specially designed needle probe allows clinicians to freeze keloids from the inside out, a procedure that has been shown to be safe, well-tolerated, and efficacious (J Clin Aesthet Dermatol. 2013;6:23-26).
Explore This IssueSeptember 2014
“This procedure works best for exophy-tic keloids,” Dr. Goldenberg said. “The lesion has to be thick enough so you can stick the probe through the keloids. If it’s really thin and flattish, it won’t work because the needle won’t get all the way through and you’ll end up freezing normal, healthy tissue.”
Larger keloids may require more than one cryotherapy session. Results vary, but most patients experience notable improvement. “Every patient does differently, but I have to tell you, from my experience, for a single treatment, it is by far the best treatment that I’ve used,” Dr. Goldenberg said.
Stem cells also show promise in the treatment of keloids. “A group in Britain looked at keloids and stem cells and found that keloids have an increased number of stem cells,” said Marc Jeschke, MD, PhD, a professor in the departments of surgery and immunology at the University of Toronto. Researchers have examined the effect of human Wharton’s jelly stem cells on keloid tissue and found that exposure inhibits keloid cell proliferation in culture (J Cell Biochem. 2014;115:826-838; Stem Cells Transl Med. 2014;3:299-307).
Dr. Jeschke is also currently investigating the utility of stem cells derived from human adipose tissue. He uses liposuction to gain adipose tissue, then isolates and harvests the stem cells, which are injected beneath a keloid scar. “The effect of those stem cells is that they dampen the inflammatory response and, in a lot of cases, cause regression of the keloids,” Dr. Jeschke said. “Effectiveness varies. We’ve had everything from fantastic results to it didn’t really work that well, and it’s hard to predict who will respond or not. But for some patients, it was incredible. The keloids were gone. They melted away.”
Will New Research Translate to Effective Treatments?
Otolaryngologists, dermatologists, and plastic surgeons are watching the advances in keloid research and treatment with interest. “I do think that the new genetic studies are going to help us understand how to prevent keloids better,” Dr. Goldenberg said. “The Holy Grail is preventing keloids as opposed to waiting for them to occur and then treating them.”