Treatment of Hypertrophic Scars and Keloids: Intralesional Corticosteroids versus Cryotherapy

Abstract

Introduction: Hypertrophic scars and keloids cause pruritus, pain, and disfigurement. This review compares intralesional corticosteroids with cryotherapy as monotherapies and in combination.

Methods: A systematic review of randomized trials and prospective cohorts was performed. Inclusion: patients with hypertrophic scars or keloids receiving either treatment. Outcomes: scar height, symptom relief, recurrence, and adverse effects.

Results: Twenty-five studies (n=1,102 patients) were analyzed. Intralesional triamcinolone achieved >50% flattening in 70% of patients at three months. Cryotherapy alone achieved 60% flattening. Combination therapy yielded 85% flattening. Recurrence rates: corticosteroids 35%, cryotherapy 40%, combination 18%. Hypopigmentation occurred in 30% of cryotherapy-treated dark-skinned patients. Pain was transient.

Discussion: Combination therapy provides synergistic effects, with cryotherapy reducing scar bulk and steroids suppressing inflammation. Adverse effects differ: corticosteroids cause atrophy; cryotherapy causes pigment changes. Patient skin type influences choice.

Conclusions: Combination intralesional corticosteroids and cryotherapy is superior to either alone for keloids. Skin type-adapted protocols are recommended for pigmented patients.