Cryotherapy may lower disease relapse among patients with alopecia areata

Key takeaways:

• A literature review found cryotherapy yielded a lower relapse rate in alopecia areata vs. other treatments.
• Adverse events such as skin atrophy, burning, pruritus and pain can be avoided with cryotherapy.

Cryotherapy may lower disease relapse in patients with alopecia areata compared with intralesional corticosteroid injections or topical steroids, according to a study.

Due to adverse events related to intralesional corticosteroid injection with triamcinolone acetonide and high rates of relapse linked to topical steroids, Michael Kaiser, BSc, of the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, and colleagues conducted a literature review to investigate cryotherapy as a safe and effective treatment modality for localized alopecia areata (AA).

“The immunomodulatory and vascular effects of cryotherapy have made it an attractive low-cost and safe potential therapeutic modality for AA,” the authors wrote.

Kaiser and colleagues found eight studies that investigated the benefits of cryotherapy on AA. Three studies assessed efficacy of liquid nitrogen cryotherapy in AA, three studies compared cryotherapy with intralesional corticosteroid injection and two studies compared cryotherapy with topical corticosteroid therapy.

The authors found no statistical difference in efficacy between the methods, but did find evidence suggesting that cryotherapy lowered relapse rates.

Additionally, studies have consistently found that injection-treated patients endure higher rates of adverse events such as burning, pruritis and pain than cryotherapy-treated patients, according to the authors.

Kaiser and colleagues further noted that the results of different regimen schedules are not consistent in the literature, making it difficult to recommend a certain therapeutic protocol. However, the authors did find that a minimum of four treatments involving at least one freeze-thaw cycle, in addition to freezing times lasting at least 8 seconds, tended to yield the best outcomes.

“The low cost and ease of availability of cryotherapy makes a strong case for further investigations for its use as part of the routine therapeutic armamentarium for AA, in both treatment-naïve patients and those who have failed or experience side effects with the gold-standard use of steroids,” Kaiser and colleagues wrote.