Cryosurgery: What are its benefits for skin prone to rosacea?

Cryosurgery is a medical technique that involves the use of extremely low temperatures, ranging between -40° and -60°C, to destroy and remove unwanted hypertrophic tissues. During cryosurgery, a cryogenic agent, such as liquid nitrogen or solid carbon dioxide, is applied to the targeted area of the skin. This causes an instant cooling of the skin tissues, leading to the formation of ice microcrystals within the cells and their subsequent destruction. Cryosurgery is often used as a non-invasive alternative to traditional surgery and is practised in many fields, such as dermatology, but also plastic surgery, oncology and sports medicine. Cryosurgery is particularly beneficial for patients suffering from rosacea.

• Cryosurgery to reduce the size of blood vessels and decrease redness.

  If cryosurgery is favoured in the case of rosacea, it is primarily due to its vasoconstrictive effect. Indeed, in response to cold, the blood vessels contract to limit the spread of the body's heat and conserve it at the level of vital organs, such as the brain, heart and lungs. This is beneficial in the case of rosacea as this skin condition is notably caused by an excessive dilation of the facial blood vessels. Their contraction due to the cold thus helps to reduce their visibility and the redness.

• Cryosurgery promotes cellular regeneration.

  When cells are exposed to extremely low temperatures, ice crystals form both inside and outside, disrupting the cellular membranes and leading to their rupture. This triggers a local inflammatory response, the first step in the healing process. The inflammation attracts macrophages, immune cells that remove cellular debris from damaged tissues. Concurrently, the release of cytokines stimulates the proliferation of fibroblasts and keratinocytes, key cells in the reconstruction of epidermal and dermal tissues. Cryosurgery thus accelerates natural regeneration of biological cells, resulting in smoother skin.

• Cryosurgery helps to reduce the appearance of papules and pustules.

  Cryosurgery has also shown beneficial effects on the papules and pustules characteristic of papulopustular rosacea. This technique works through a immunomodulatory action. Indeed, the cold initially stimulates inflammation before giving way to an anti-inflammatory effect 24 to 48 hours after the operation, allowing the lesion to be absorbed. Subsequently, cryosurgery induces an increase in anti-inflammatory cytokines and a decrease in interleukin and prostaglandin levels, which helps to reduce inflammatory lesions such as papules and pustules.

• Cryosurgery for the treatment of rhinophyma.

  Cryosurgery is frequently employed in the context of rhinophyma. To clarify, rhinophyma is an advanced stage of rosacea characterised by an enlargement of the sebaceous glands and connective tissue of the distal part of the nose, leading to its thickening. The cold applied during cryosurgery allows for the burning of the entire affected surface and to destroy the damaged cells by freezing. The removal of unwanted tissues is then carried out using a scalpel.

  A clinical trial conducted on a 65-year-old patient suffering from rhinophyma demonstrated a good efficacy of cryosurgery on this particular form of rosacea. The patient had a pronounced rhinophyma, which had been worsening for five years in the absence of prior treatment. An improvement was noticed after the third treatment session. In total, seven sessions of cryosurgery were carried out, yielding very satisfactory results, as attested by both the patient and the researchers. Following the sessions, the patient's nasal surface was much smoother.

Even though it is less invasive than traditional surgery, cryosurgery is not suitable for everyone suffering from rosacea. It is particularly contraindicated for pregnant women as the phenomena of vascular redistribution could be harmful to the foetus. Moreover, individuals with dark skin are advised to exercise caution as this technique carries a risk of hypopigmentation. It is worth noting that while rosacea predominantly affects those with fair skin, those with a darker phototype are not completely spared. Lastly, cryosurgery is not recommended for patients who have recently undergone another surgical procedure, in order to reduce operative risks.

As for the side effects of cryosurgery, they remain relatively rare. Following a session, the skin may locally exhibit redness or swelling due to the cold. Blisters may also appear, giving way to scabs during their healing process, which fall off within a few days. It is necessary to refrain from picking these scabs, to avoid poor healing. Furthermore, some pain may be felt in the hours following the session. After cryosurgery, it is necessary to avoid any friction with the wound and to apply a healing cream daily, usually prescribed by the dermatologist. Finally, it is recommended to avoid sun exposure and to apply daily sun protection.

Cryosurgery should not be performed alone but under the supervision of a healthcare professional. By carrying out this treatment at home, the patient exposes themselves to high risks of infection and haemorrhage. Furthermore, the patient's lack of knowledge about this practice poses an additional risk.

• COHEN E. & al. Cryotherapy for rosacea. Postgraduate Medical Journal (1948).

• RUBINSKY B. & al. Cryosurgery. Annual Review of Biomedical Engineering (2000).

• PELLE M. & al. Rhinophyma treated with cryosurgery. Dermatologic Surgery (2009).