Histological Comparison of Two Cryopeeling Methods for Photodamaged Skin

Background. Cryopeeling is a technique that uses cryotherapy not only on actinic keratoses lesions, but also all over the photodamaged skin. Objectives. To investigate the histological changes induced by two cryopeeling methods (liquid nitrogen (LN) and portable system (PS)). Methods. Sixteen patients with multiple actinic keratoses on the forearms were treated with cryopeeling technique using LN for one forearm and PS for the other, randomly. Skin biopsies were taken before and after the procedures. Results. There was no statistical difference between the epidermal and Grenz zone thicknesses or density of elastic fibers after treatments. The amount of melanin pigment was lower after PS treatment . In a blind analysis of paired pre- and postprocedure slides, it was not possible to identify cases which underwent treatment, both in global analysis of quality of the skin and in specific analysis (considering only the aspect of stratum corneum). Discussion. The results indicate the inconsistency of histological improvement after treatments, and, likely, since the method causes superficial exfoliation, a reliable marker was not found in the analysis. Conclusions. Despite cosmetic benefits on photodamaged skin and efficient treatment of actinic keratoses lesions, cryopeeling was not able to induce measurable histological changes in solar elastosis, epidermal organization, or epidermal and Grenz zone thicknesses. One should keep in mind the possibility of hypopigmentation risk of the method. 1. Introduction Cryotherapy using liquid nitrogen (LN) is the most common form of treatment of actinic keratosis [1]. It is an easy access option for dermatologists with good cost benefit in the treatment of these lesions [2–4]. A portable system (PS) is a more recent alternative for cryotherapy, which uses gases (dimethylether, propane, or isobutane) in a portable plastic container. In this method the tip may achieve a temperature of ？55°C. Using LN, whose boiling point is ？196°C, the temperature to be achieved in the tissue for the treatment of malignancies is between ？50°C and ？60°C [5]. Cryopeeling is a technique that uses cryotherapy in a diffuse manner throughout the skin region affected by sun damage in order to promote cell renewal and desquamation, with possible benefits in the appearance of new lesions caused by photodamage. Few studies were performed evaluating cryopeeling technique until now [3, 6, 7]. The results obtained with cryopeeling treating actinic keratoses were satisfactory and more effective than 5-fluorouracil. It seems that cryopeeling is