Cryotherapy may be more effective than intense pulsed light (IPL) monotherapy for treating hypertrophic scars, but a cryotherapy approach may be associated with a greater rate of largely reversible complications, study data published in the Journal of Cosmetic Dermatology suggests.
A total of 28 patients from 6 to 40 years of age with hypertrophic scars were included in this study. Patients were randomly assigned to receive either cryotherapy (n=14) or IPL (n=14). Treatments were performed for a total of 6 sessions or until the lesion resolved. The outcome of scar resolution was evaluated both clinically and histopathologically.
Patients assigned to cryotherapy had a significant decrease in scar height (P =.001) and a significant improvement in scar color (P =.021) and pliability (P =.006). In contrast, the investigators noted, treatment with IPL was not associated with a significant decrease in scar height (P =.066) or significant improvement in scar color (P =.102). There was a significant difference after treatment with IPL in terms of scar pliability (P =.046). The mean Vancouver Scar Scale decreased by -53.7% after cryotherapy (P <.001) vs -11.5% decrease after IPL (P =.477).
Epidermal thickness after cryotherapy increased by 90.21%±86.65 with corresponding returning of the rete ridges pattern. In addition, dermal thickness decreased by -16.00%±7.40. Thin horizontally oriented, parallel new collagen bundles replaced irregular collagen bundles. After IPL, epidermis thickness increased by 1.96%±4.98 and the dermis decreased by -3.29% ± 4.25 (P <.05 between groups).
All complications reported in this study were reversible. Cryotherapy was associated edema (42.8%) and slow recovery (57%), rates of which were significantly greater compared with that observed in the IPL group (P =.021 vs P =.004, respectively). The use of cryotherapy was also associated with nonsignificantly higher rates of hypopigmentation (21.4%), wound infection (21.4%), and necrosis and/or ulceration (21.4%). All patients in the cryotherapy arm reported pain vs only 35.7% of patients in the IPL group (P =.002).
Aside from the small patient sample, this study was limited by the inclusion of only Egyptian patients with Fitzpatrick skin types 3 and 4, which may have contributed to the relatively low efficacy of IPL.
In addition, the mature nature of some of the scars may have played a role in the low efficacy rate of IPL in this study. To that end, the investigators suggest “IPL should be reserved for hypertrophic scars of recent onset with further studies on the modulation of the IPL parameters and the number and spacing of sessions to get the best response” in patients with skin types 3 and 4.
Salem SAM, Abdel Hameed SM, Mostafa AE. Intense pulsed light versus cryotherapy in the treatment of hypertrophic scars: A clinical and histopathological study. J Cosmet Dermatol. Published online February 2, 2021. doi:10.1111/jocd.13971