Cold Anesthesia Well-Tolerated, Reduced Pain in Injections for Nodulocystic Acne

In patients with nodulocystic acne, cryoanesthesia was efficacious in reducing pain during intralesional triamcinolone steroid injections.

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During a study,¹ investigators sought to evaluate the safety and pain-reduction effects of a newly-introduced cryoanesthesia device, CryoVIVE, in clinical settings. CryoVIVE is the first device of its kind, used to cool skin temperatures with precise control.

The 2-staged, non-randomized clinical trial involved a total of 64 patients with nodulocystic acne lesions. Prospective participants were excluded from study participation if they were pregnant, breastfeeding, or had an existing skin condition with the potential to increase their risk of infection.

Stage 1 of the trial used a controlled pilot trial to determine the therapy’s safety and efficacy. During this stage, 34 participants received triamcinolone acetonide (TA) injections for their affected acne lesions. These injections were accompanied by cryoanesthesia.

During stage 2 of the trial, 30 adult patients older than 18 years of age underwent intralesional TA injections combined with cryoanesthesia for at least 2 acne lesions. Researchers evaluated the safety and efficacy of the combination therapy using split-face comparison.

Prior to administering TA injections, investigators cleansed participants’ treatment areas with a cleanser and refrained from using any other pain management therapy. All participants received 2.5 mg/mL TA injections on 1 side of the face. Investigators disinfected the CryoVIVE device prior to and after use using benzalkonium chloride cleaner. On the other side of the face, participants received TA injections accompanied by use of the CryoVIVE device, which was set between 0 and 3 degrees Celsius.

Researchers evaluated participants’ intensity of pain using the Visual Analogue Scale (VAS) following treatments with and without cryoanesthesia. Additionally, researchers used a numeric 1 through 10 scale to evaluate participant satisfaction. During and after treatment, researchers and participants reported any adverse events (AE).

With stage 2 of the trial only, researchers compared paired t-test scores between acne lesions treated with and without cryoanesthesia.

As a result, the average VAS score of TA injections accompanied by cryoanesthesia in stage 1 was 2.80 ± 0.79. In stage 2, the average VAS score of TA injections was 5.933 ± 2.03, while the average score when coupled with cryoanesthesia was 3.667 ± 2.23.

In lesions treated without cryoanesthesia, participants had an average subjective satisfaction score of 3.867, while the average score was 2.5 with cryoanesthesia.

Side effects were not reported in either stage.

Study limitations, as noted by researchers, included the lack of placebo or randomization.

“Our study shows that the cryoanesthesia reduces pain without any observed adverse events. Moreover, CryoVIVE improves pain sensation with intralesional corticosteroid injections,” study authors wrote. “The anesthetic use of CryoVIVE with corticosteroid injections is a practical, well-tolerated modality that minimizes discomfort during dermatological procedures, in the absence of any other anesthetic methods.”

Reference

1. Park SJ, Shin SH, Koh YG, Kim G, Rho NK, Park KY. Cold anesthesia for pain reduction during intralesional steroid injection for nodulocystic acne. J Cos Dermatol. Published online 2023. doi:10.1111/jocd.15829