H11: A chilling history of cryotherapy

Helena Wells and Anthony Abdullah

Corbett Hospital, Amblecote, UK

Cryotherapy is the use of low temperatures to deliver destruction of tissue; practice in dermatology includes the treatment of malignant and premalignant skin lesions. Presently, liquid nitrogen is used, which has a boiling point of –195·8 °C. The healing properties of cold were first recognized by the Ancient Egyptians in 1700 bc and Hippocrates in 400 bc, who both documented its merits in relieving pain. Napoleon’s surgeon recognized its anaesthetic effects when amputating limbs injured in battle. However, the surgical use of cold has mainly evolved over the last 200 years. In the 1850s James Arnott demonstrated the use of cold to relive pain caused by migraines, through a device for the application of cold holding a salt and crushed ice solution. He intended to widen its use to include treatment of cancers (Cooper M, Dawber R. The history of cryosurgery. J R Soc Med 2001; 94: 196–201). Launched at the Great Exhibition in London in 1851, the apparatus was cumbersome and did not cool as intended. The device did not take off. Advancements in cryotherapy began in the nineteenth century, when a vessel for transportation of liquified gas was created in the form of a vacuum flask. Trends moved towards solid carbon dioxide, which became freely available as a common refrigerant (–78·5 °C). Liquid oxygen (–182·9 °C) was introduced in the 1920s and had promising results, but also carried the hazard of combustibility. Liquid nitrogen (–196 °C) became commercially available in the 1950s, following the Second World War. Its uses were recognized by Dr Ray Allington, who wiped liquid nitrogen-soaked cotton swabs onto warts, seborrhoeic keratosis and eczema. A prototype similar to modern cryotherapy flasks was created in 1961 by Dr Irving Cooper and Arnold Lee, who developed a device that, under pressure, released liquid nitrogen. The purpose of this was for treating neurological diseases such as Parkinson disease, and its use was expanded to include neoplasms such as prostate cancer. Cryotherapy has become more experimental, and ‘whole-body cryotherapy’ is popular in the USA to treat chronic dermatosis. As this is not evidence based, dermatologists have expressed concern. Perhaps the future will see more specific and targeted devices, its reintroduction to other surgical disciplines and even robotic delivery. Retinal cryopexy can be used to treat retinal detachments by creating a chorioretinal scar, and a handheld pen is newly marketed, which may have a future in dermatological practice.