Case Report Subcutaneous Emphysema Induced by Cryotherapy: A Complication due to Previous Punctures Jared Martínez-Coronado, Bertha Torres-Álvarez, and Juan Pablo Castanedo-Cázares Department of Dermatology, Hospital Central “Dr. Ignacio Morones Prieto”, Universidad Autonoma de San Luis Potos´ ı, 2395 Venustiano Carranza Avenue, 78210 San Luis Potos´ ı, SLP, Mexico Correspondence should be addressed to Juan Pablo Castanedo-C´ azares; castanju@yahoo.com Received 17 March 2015; Accepted 1 June 2015 Academic Editor: Mario Vaccaro Copyright © 2015 Jared Mart´ ınez-Coronado et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse efects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy afer multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved afer expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be frst administered or a cotton-tip applicator should be used. 1. Introduction Modern cutaneous cryosurgery was introduced in the 1960s [1], since then it is commonly used by most dermatologists around the world. It is recognized that this treatment was frst applied in 1974 for keloidal scars by Pirece [2]. Cryotherapy induces vascular damage that leads to anoxia and tissue necrosis reducing the keloidal scar thickness [2, 3]. Tus, it is not an innocuous treatment and dermatologist must be aware of its side efects which can be immediate or delayed. Frequent short-term adverse features include pain, syncope, hemorrhage, edema, blistering, fever, infection, and pyogenic granuloma [1, 3]; long-term changes consist in permanent hypo- or hyperpigmentation, pseudoepitheliomatous hyper- plasia, milia, nerve damage, alopecia, scar formation, and car- tilage necrosis [1, 3]. We report a patient with keloid scar who presented subcutaneous emphysema afer cryotherapy appli- cation, an uncommon complication fnding in dermatologic literature [4–7]. 2. Case Report A 28-year-old woman presented with an 18-month history of 2 × 10 cm keloid scaring induced by acne vulgaris on the upper frontal thorax. Her lesion was frst locally anesthetized with intralesional lidocaine and aferwards infltrated with acetonide of triamcinolone, followed by two 40-second cycles of sprayed cryotherapy. Te patient came back to our facilities 30 minutes afer the procedure because the upper area of the treated zone started to bulk. Physical examination only revealed swelling and cutaneous crepitus on palpation. Tere was no erythema or pain, nor local increased temperature. Vital signs were normal and there were no systemic symptoms other than minor anxiety triggered by this outcome. We made clinical diagnosis of subcutaneous emphysema as a complication of cryotherapy due to the timeline of the clinical history: punctures followed by sprayed cryotherapy and then a prompt presence of local subcutaneous emphysema. Te patient was retained in our facilities and afer one hour of observation the skin became normal in appearance. However, subcutaneous crepitation continued upon complete resolution afer three days. Clinical changes are shown in Figure 1. 3. Discussion Subcutaneous emphysema (SE) is defned by the presence of air or other gases within the sof tissue compartment Hindawi Publishing Corporation Case Reports in Dermatological Medicine Volume 2015, Article ID 374817, 3 pages http://dx.doi.org/10.1155/2015/374817