Highlights from

American Academy of Dermatology

annual meeting 2018

San Diego 16-20 February 2018

Intralesional cryosurgery and itching in psoriasis

Intralesional cryosurgery effective for keloids

Extreme cold is a novel treatment approach for hypertrophic scars or keloids [7]. Prof. Yaron Har-Shai of the University of Technion treated 380 Caucasian patients with keloids by inserting a cryo-needle into the core of the scar, applying liquid nitrogen, and thus freezing the HSK from the inside.

His patients were aged 3 to 67 years and 204 were female. In total, these patients suffered from 448 keloids in different locations of their bodies for over six months, originating, for example, from trauma, surgery, burns, piercings and acne. After the procedure, the change of scaring was followed over 18 months for objective transformation in volume, hardness, redness and pigmentation. Furthermore, clinical symptoms such as pain or tenderness, itch or other discomfort were monitored. Biopsies were evaluated for changes in collagen structure and the post-interventional blister fluids analysed for their proteome.

As a result, keloids on the ear lost 67% of their volume after a single session. The reduction of lesions on chest and upper back/shoulders were 50% and 60%. A significant decrease in both clinical and objective symptoms was reached with a non-responder rate of only 3%.

The histological work-up revealed a rejuvenation of the treated tissue, demonstrated by reorganisation of collagen fibres, amongst other signs. The proteomic examination revealed specific proteins known to be linked to cell and stem cell differentiation and response to stress and injury.

Itching in psoriasis- more important than often thought

While pruritus occurs in the majority of psoriasis patients, it is rarely in the centre of efficacy control during trials [8]. An Australian, observational, cross-sectional study included 179 patients to look for prevalence and exacerbating factors of itching in psoriasis. The study subjects were predominantly Caucasian and 45% were female. 65% had a PASI <10 and 89% suffered from plaque psoriasis. The mean age was 52.3 years. 24% were being treated with biologics and 47% by phototherapy [9].

Altogether, 49% reported having itching most or all of the time while, in 11%, itching never occurred [8]. Dr Philippa Dickison of the University of Sydney proposed a seasonal difference in itch severity, the worst time being winter. Pruritus, for instance, also went up during flares, under stress, and after taking a shower.

Interestingly, in patients with nail psoriasis, itching was less often omnipresent. Dr Dickison hypothesised this may be due to scratching in this area being difficult; thus, maybe making the occurrence of a scratch-itch cycle less likely. It was noted before that, in psoriasis, the disease severity is not necessarily associated with the intensity of itching, but the itch has great influence on QoL [10]. Although itch was 2.2 times more likely in patients with PASI >10, the improvement of PASI did not always lead to a reduction in itching to the same extent [8].

  1. Har-Shai, Y. P6222, AAD Annual Meeting, February 16–20 2018.
  2. Dickison, P. et al. P5879, AAD Annual Meeting, February 16–20 2018.
  3. Dickison, P. et al. Australas J Dermatol 2017 Dec 26.
  4. Reich, A. et al. Acta Derm Venereol 2010;90:257–63.

Top image: © kali9

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.