From the Guidelines
Cryotherapy is a highly effective first-line treatment for isolated actinic keratosis lesions, as strongly recommended by recent guidelines 1. The procedure involves applying liquid nitrogen to the lesion for approximately 5-10 seconds, creating controlled tissue destruction that eliminates the abnormal cells. For optimal results, the freeze time should create a 1-2mm halo of frozen tissue around the lesion. Most lesions require only a single treatment, though thicker lesions may need a second freeze-thaw cycle during the same session or a follow-up treatment in 2-4 weeks. After treatment, patients can expect redness, swelling, and blister formation, followed by crusting and healing within 1-2 weeks. Some key points to consider when using cryotherapy for actinic keratosis treatment include:
- The use of UV protection is strongly recommended for all patients with actinic keratosis 1
- Topical treatments like 5-fluorouracil (5-FU) cream or imiquimod 5% cream may be more appropriate for patients with multiple lesions or field cancerization 1
- Photodynamic therapy is another effective option for widespread lesions, with conditional recommendations for its use 1
- The combined use of 5-FU and cryosurgery, or imiquimod and cryosurgery, may be conditionally recommended for some patients 1 Cryotherapy works by causing direct cellular damage through ice crystal formation and vascular stasis, triggering an inflammatory response that helps eliminate the abnormal tissue while preserving the underlying dermis structure, which explains its favorable cosmetic outcomes. In terms of specific treatment recommendations, the guidelines suggest that:
- Cryosurgery is a strongly recommended treatment option for actinic keratosis 1
- The use of diclofenac may be conditionally recommended for some patients, although it carries a black box warning for cardiovascular and gastrointestinal side effects 1
- Photodynamic therapy may be conditionally recommended for patients with widespread lesions, although the evidence for its use is generally of lower quality than that for cryosurgery or topical treatments 1
From the Research
Actinic Keratosis Treatment Options
- Actinic keratosis (AK) is a premalignant lesion that can evolve into squamous cell carcinoma, and various treatment options are available, including 5-fluorouracil, cryotherapy, diclofenac, photodynamic therapy (PDT), imiquimod, retinoids, and ingenol mebutate 2.
- The choice of treatment depends on the individual case, and a combination of therapies may be used to reduce duration and side effects 2.
Cryotherapy for Actinic Keratosis
- Cryotherapy is a standard first-line approach for single lesions and is considered a destructive procedure 3.
- It is effective in treating AK, but its efficacy and safety can vary depending on the technique and individual case 3.
- Compared to other treatments, cryotherapy has been shown to have lower cosmetic outcomes than photodynamic therapy (PDT) and imiquimod 4.
- However, cryotherapy is still a recommended treatment option for AK, especially for individual lesions 4, 3.
Comparison of Treatment Options
- A study comparing different treatment options found that 3% diclofenac, 0.5% 5-fluorouracil, 5% imiquimod, and 0.025% to 0.05% ingenol mebutate had similar efficacy, but different adverse events and cosmetic outcomes 4.
- Photodynamic therapy (PDT) was found to be more effective and have better cosmetic outcomes than cryotherapy for individual lesions 4.
- Topical therapies such as 5-fluorouracil and imiquimod are also effective options for treating AK, especially for multiple lesions 5, 6.