The NEA research team has published its latest paper on the out-of-pocket (OOP) costs of atopic dermatitis (AD) in the U.S. — this time examining OOP costs among caregivers of children with AD compared to adults.
Published On: Dec 2, 2021
Last Updated On: Dec 2, 2021
Cryotherapy is everywhere these days. Lebron James does it. So does Serena Williams. But it’s not just for celebrity athletes anymore.
NEA Ambassador Patricia Cervini uses cryotherapy every week to manage her eczema. NEA Board Member Lynell Doyle said her son Bryson was finally able to get a good night’s sleep after his own cryotherapy experience during the worst of his summer flaring. Healthcare providers around the country have started prescribing cryotherapy to treat a variety of medical conditions including arthritis, chronic pain and even prostate cancer. With more cryotherapy centers popping up every week, people with eczema have started asking questions about whether this new therapy could help their symptoms.
But how does it really work? Is it worth the cost? And could it be dangerous?
Cryotherapy, or “cold therapy,” is the process of cooling the surface of your skin for two to four minutes in order to constrict the body’s blood vessels and decrease internal inflammation. The procedure takes place in a metal cooling chamber that encircles your whole body except for your head. Liquid nitrogen then cools the air in the chamber down to negative 200 degrees Fahrenheit (or colder) while you stand and count down the seconds until your time is up.
In response to the extreme temperature, your brain activates your circulatory system into overdrive. Your blood flow increases and you experience a rush of serotonin and endorphins. Clinics usually provide gloves and foot-coverings to prevent frostbite on your outermost appendages. And once it’s over, you step out of the tank, get dressed, and go about your day. There’s very little time needed to “warm up” once it’s over. The whole process takes less than 30 minutes.
People who have tried cryotherapy report a wide variety of benefits ranging from pain relief, help with weight loss, prevention of migraines and decreased symptoms of anxiety and depression.1
The short answer is yes, but proceed with caution. Dr. Gil Yosipovitch chairs the Department of Dermatology at Miami University and said that “there are some patients with atopic dermatitis who report that their eczema improves with extreme cold.” Since eczema is not a ‘one size fits all’ condition, it’s difficult to predict how an individual might respond to a novel form of treatment like cryotherapy: for one person, a scorching hot shower may sound soothing for their skin, whereas another person with eczema may find the very opposite appealing — an ice cold bath. Dr. Yosipovitch alluded to as much: “There are patients with eczema who report that their skin improves significantly with cold showers,” she said. “And these would be the perfect candidates to try cold therapy treatment.”
Patricia Cervini lives with moderate to severe eczema and uses cryotherapy multiple times a week. “In my experience with having eczema,” she said, “cryotherapy definitely helped with both the itch and pain.” Patricia used the words “immediate relief” to describe the effect of cryotherapy on some of her most persistent flares. For her, the only negative was the cost. “It would be a dream come true if health insurance covered cryotherapy.”
Lynell Doyle brought her teenage son Bryson to a cryotherapy center during a summer when he was experiencing relentless flares. “The first time he got it,” she said, “he was able to sleep through the night for the first time in months.” Lynell articulated one of the challenges of cryotherapy: it’s unclear how or why exactly it works. “I did not feel that it directly reduced his eczema,” she said, “but it made him comfortable, reduced his pain and reduced his need to itch his skin, and all of that helped his skin heal. Therefore, maybe indirectly, the cryotherapy did help his eczema.”
Dr. Brian Kim is the co-director of the Center for the Study of Itch and Sensory Disorders at Washington University School of Medicine in St. Louis, Missouri. He pointed out that there are reports of cryotherapy helping people with eczema but no “rigorous, randomized controlled trials.” He added that “there’s reason to believe cooling therapy is calming to the nerves and also anti-inflammatory,” while advising caution about considering cryotherapy because “the mechanism of action is not clear” and that conventional cryotherapy remains somewhat imprecise.
For people who flare in specific locations, as opposed to their entire body, there’s also the option of having targeted cryotherapy with a wand; this is an alternative to the full-body chamber method. Patricia Cervini explained how and why the cryo-wand was the right choice for her. “Dupixent had healed the eczema flares on my body,” she said, “but I was still struggling with flares around one eye and my eyebrows. I tried a cryo facial, which involves administering the cryo wand around my face. It only took twelve minutes, and it helped immediately.”
Children under the age of 12 are not allowed to use the full body cryo chamber, so Lynell had tried the localized treatment for her son Bryson first. “He was just a kid and he was in such anguish,” she said. “So we did it three times a week for a span of four weeks, and it cost $125 per week. I think it’s worth it to give it a try, especially during an intense flare, but you need to be comfortable with the therapist and have a candid conversation about your goals for the therapy.”
Before you consider cryotherapy, it’s worth educating yourself about the potential risks. Dr. Yosipovitch pointed out that “extreme cold can cause significant dry cracked skin, blisters and even frostbite in the fingers or toes.” Dr. Kim added that uncontrolled cryotherapy could lead to “dyspigmentation and scarring.” Because of the risks, both Lynell and Patricia articulated how important it is to work with a trusted facility, where a cryo-therapist can monitor your health and level of comfort throughout the entire experience. And even if you don’t experience any negative physical consequences, it’s important to remember how much this untested therapy costs. With the average cost per session ranging from $70 to $120, it can add up quickly.
Dr. Yosipovitch mentioned a small 2008 Finland study published in JAMA Dermatology that explored the effect of cryotherapy on people with eczema in comparison to phototherapy. The study found that cryotherapy “clearly has a steroid-sparing effect with additional statistically and clinically significant improvements in pruritus and sleep disturbances.”1 The researchers observed that some participants continued “improving even after the treatment period” and suggested that future studies should analyze a higher number of treatment sessions over an extended period of time. With such a small sample size, too (11 out of 18 patients completed the treatment period), additional studies are needed.
More recently, the Journal of Cosmetic Dermatology published the results of a study whose data “suggest that a novel cryotherapy device may improve itch in patients with mild-to-moderate atopic dermatitis.”2 The study’s sample size only included 28 patients, and of those only 12 completed all of their follow up visits. More than half of the participants reported “poor satisfaction,” whereas a small group of patients noted “substantial improvement.” This may reinforce Dr. Yosipovitch’s observation that there exists a subset of people with eczema who improve with cold water and therefore could also potentially see improvements with cryotherapy. For people whose eczema is aggravated by cold temperatures, Dr. Yosipovitch said: “I would recommend they stay away from this therapy.”
If you live with eczema, you probably already know how your skin would respond to a blast of icy cold air. Before trying cryotherapy, be sure to schedule an appointment with a healthcare provider who you trust, who understands your eczema, and talk through the pros and cons. If, like Lynell’s son Bryson, the cryotherapy may bring you a good night’s sleep during the worst of your flaring, it may be worth considering.
If you live with eczema, you probably already know how your skin would respond to a blast of icy cold air. Before trying cryotherapy, be sure to schedule an appointment with a healthcare provider who you trust, who understands your eczema, and talk through the pros and cons.