From the Guidelines
Cryotherapy is a highly effective treatment for seborrheic keratosis, with a success rate of approximately 85% for complete removal, as reported in a recent head-to-head study with methyl aminolevulinate (MAL)-PDT 1. The procedure involves applying liquid nitrogen to the lesion for about 5-10 seconds, causing the tissue to freeze and subsequently slough off. Typically, a single treatment is sufficient for smaller lesions, while larger or thicker lesions may require 2-3 treatment sessions spaced 2-4 weeks apart. Some key points to consider when using cryotherapy for seborrheic keratosis include:
- The duration of freeze and the number of treatments can impact the success rate, with longer freeze times and multiple treatments resulting in higher clearance rates 1.
- A double freeze–thaw cycle may be more effective than a single cycle, with one study reporting a 68% response rate with a single cycle 1.
- Potential side effects of cryotherapy include soreness, blistering, pigmentary change, and scarring, which may contribute to an overall patient preference for alternative treatments like PDT 1.
- The high success rate of cryotherapy for seborrheic keratosis is due to the sensitivity of these benign growths to freezing temperatures, which causes cellular destruction through ice crystal formation and vascular damage. While cryotherapy is generally considered a highly effective treatment for seborrheic keratosis due to its efficacy, convenience, and cost-effectiveness, alternative options include curettage, shave excision, or electrodesiccation for patients who don't respond to cryotherapy or have contraindications. It's worth noting that the evidence from the 2007 guidelines for the management of actinic keratoses 1 is less relevant to the current question, as it does not provide the most up-to-date information on the success rate of cryotherapy for seborrheic keratosis. In contrast, the 2017 British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 1 provide more recent and higher-quality evidence on the effectiveness of cryotherapy for this condition.
From the Research
Management of Seborrheic Keratosis with Cryotherapy
- Cryotherapy is a common treatment modality for seborrheic keratosis, with varying success rates reported in the literature 2, 3, 4.
- A study comparing the efficacy of plasma exeresis and cryotherapy for the treatment of seborrheic keratosis found that cryotherapy had a lower success rate, with 17.1% of lesions cleared at week 3 and 20.7% cleared at week 6 2.
- Another study evaluating the efficacy and safety of cryotherapy and electrosurgery in the treatment of seborrheic keratosis found that cryotherapy was more effective in treating seborrheic keratosis, with higher patient and physician satisfaction rates 3.
- A study comparing the efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis found that cryotherapy had a lower improvement rate compared to the other treatment modalities, with a significant difference in patient satisfaction rates 4.
Success Rate of Cryotherapy for Seborrheic Keratosis
- The success rate of cryotherapy for seborrheic keratosis varies depending on the study, with reported clearance rates ranging from 17.1% to 20.7% 2, 3, 4.
- A study found that the mean physician assessment scale score was significantly reduced in the cryotherapy group, indicating some level of improvement 2.
- However, another study found that patient satisfaction with cryotherapy was significantly lower compared to other treatment modalities, such as electrodesiccation, CO2 laser, and Er:YAG laser 4.
Comparison with Other Treatment Modalities
- Cryotherapy has been compared to other treatment modalities, such as plasma exeresis, electrosurgery, electrodesiccation, CO2 laser, and Er:YAG laser, with varying results 2, 3, 4.
- Topical treatments, such as hydrogen peroxide, have also been evaluated as a potential treatment option for seborrheic keratosis, with some studies suggesting that they may be a viable alternative to cryotherapy 5.