Whole body cryotherapy

Whole body cryotherapy (WBC) performed at WBC centers has been trending as a health and beauty procedure over the past few years.

WBC has been purported to manage pain, reduce inflammation, and speed up recovery after injury, as well as relieve sore muscles after exercise, aid in weight loss, and improve mood. There have also been claims that it can treat acne, eczema, and psoriasis – even multiple sclerosis, fibromyalgia, and rheumatoid arthritis. It has been used as a beauty aid to reduce pore size and reduce wrinkles. Its popularity has exploded as centers are advertised on discount sites such as Groupon and Living Social, and it is now available as classes in the popular exercise app ClassPass as “Whole Body Cryotherapy” or a “CryoBeauty Facial.”

Despite these claims and popularity, research studies have yet to prove that WBC can deliver any of these benefits. The American Academy of Dermatology has released a statement for consumers that does not support its use. Because of the lack of research, WBC has not been cleared by the Food and Drug Administration for treating any medical indication.

Its popularity has to stem from somewhere. In many cultures, cold therapy has been used for health benefits for centuries. For example, Turkish, Russian, Finnish, Roman, and Chinese spas offer cold baths at 50 degrees Fahrenheit after heat therapy (saunas, baths) as a form of hydrotherapy to alter circulation for health benefits, with the goal of releasing toxins with heat, then closing pores and bringing the circulation back to the body’s core with cold therapy. Cold ice baths and ice packs are used by athletes routinely after games, practices, and injuries to reduce inflammation. How is WBC different?

With WBC, a person who is nearly nude enters a cold chamber of minus 200 degrees Fahrenheit, in sessions that typically last 2-4 minutes.

While the majority of those who engage in WBC have not had complications, the AAD statement refers to a Finnish study that found that 16% of individuals exposed to WBC had mild frostbite. In 2011, U.S. sprinter and Olympic gold medalist Justin Gatlin developed frostbite on both feet after a WBC session. Additional WBC-related complications that have been reported include a frozen limb (a frozen arm in a woman in Dallas in 2013, after a 3-minute session, manifesting as painful swelling, blisters, and third-degree burns – a more severe type of frostbite), and cold panniculitis (JAAD Case Rep. 2018;4:344-5). Others include eye injuries, temporary loss of memory, and even death due to suffocation, reportedin 2015, of a staff member at a cryotherapy center outside of Las Vegas who went into a tank alone after hours when no one else was around.

Cryotherapy, when delivered to specific areas of the skin by a dermatologist, is a useful low-risk treatment. Postinflammatory pigment alteration can occur, but there has been great success in using the treatment locally for warts, actinic keratoses, and other benign skin growths, when it is done done by trained professionals. Granted, while localized cryotherapy to treat a skin growth is not the same as whole body cryotherapy, the same types of complication risks should be considered, including postinflammatory pigment alteration, particularly in skin of color, as cryotherapy can be toxic to melanocytes.

Before it is completely discounted, if it makes the person feel good or better, perhaps if the patient and practitioner are aware of the risks and how to identify and manage them, cold therapy could be useful. I once had a patient who described great relief with WBC after a Fraxel laser treatment, when herface felt like it was “on fire” despite refrigerated topical Biafine, cold air, and ice packs. As with most treatments, if someone feels better, they often look better.

While medical or aesthetic benefits ofWBC have not been proved and WBC has definite risks, if the procedure is done in an appropriate and responsible way, perhaps the benefit could outweigh the informed risks for some patients. Claims should not be advertised until they are proven, so that patients are not misinformed. The same is true of chemical peels, microneedling, hyperbaric oxygen, and vitamin drips, which are provided over the counter in nonmedical settings for health and beauty uses. Medical history should be taken into account with WBC by the facility and the practitioner, including history of blood clots, smoking, vasculitis, Raynaud’s disease, autoimmune conditions, neuropathy, and prior history of frostbite. Perhaps these should be contraindications to WBC and mechanisms should be in place to manage complications should they occur. Better regulation of WBC is needed so that the procedure can be done effectively and safely.