Cryotherapy for Keloids Redefined: The Role of Injector Plate in Large Keloid Treatment

Problem Faced Keloids are a challenging dermatologic condition characterized by excessive scar formation. Traditional treatments, including intralesional corticosteroids, surgical excision, and conventional cryotherapy, frequently result in an incomplete response. 1 Cryotherapy, delivered through cryo-spray or single-needle application, has shown limited efficacy due to inconsistent freezing and inadequate depth of penetration. These limitations necessitate a more effective and precise therapeutic approach. 2 Solution Proposed The injector plate-based cryotherapy technique involves simultaneous and controlled cryogen delivery through multiple needles inserted into the keloid. The injector plate employed in this procedure was originally designed for mesotherapy applications. The injector plate has been repurposed in an innovative manner to facilitate the delivery of intralesional cryotherapy for larger keloids. This adaptation improved treatment efficacy by enabling uniform cryogen distribution across the lesion, while simultaneously minimizing procedural discomfort. After obtaining informed consent, the keloid on the anterior chest was aseptically prepared, and local anesthesia was administered. Three 18-gauge needles 1 cm apart attached to the injector plate were inserted into the keloid. The injector plate was subsequently connected to a medical-grade silicone tubing, which is a part of the keloid cryoprobe. This was followed by liquid nitrogen delivery through the injector plate Figure 1 until freezing of the entire lesion and an additional 5 mm of healthy appearing skin was achieved Video 1. Care was taken to protect the skin at the needle exit points by orienting the bevel ends upward. Two freeze–thaw cycles were performed. Significant improvement was observed after three such cycles at 4 weekly intervals, with reduction in keloid size, pruritus, and discomfort Figure 2a and 2b. Figure 1: Three 18 G needles connected to the injector plate which is further connected to keloid cryoprobe attached to the cryogun "href": "Single Video Player", "role": "media-player-id", "content-type": "play-in-place", "position": "float", "orientation": "portrait", "label": "", "caption": "", "object-id": {"pub-id-type": "doi", "id": "", "pub-id-type": "other", "content-type": "media-stream-id", "id": "1ₐdmm8hvn", "pub-id-type": "other", "content-type": "media-source", "id": "Kaltura"} Figure 2: Keloid at baseline (a) and satisfactory improvement seen at 16 weeks (b) of follow-up after 3 sittings of intralesional cryotherapy with the injector plateInjector plate-based cryotherapy is an innovative, cost-effective, and efficient modality for the treatment of large keloids, addressing the limitations of traditional cryotherapy. Authors’ contributions The manuscript has been read and approved by all authors. All authors meet authorship criteria and that the manuscript represents honest work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies