The use of extreme cold to improve health is called cryotherapy. Interventions range from trendy full-body cold immersion in spas to specific, localized applications of cold in medical settings. Targeted cryotherapy is the application of extreme cold, usually in the form of liquid nitrogen, to freeze an affected area of skin. Freezing the area causes the tissue to die, and through a phenomenon known as the reverse Koebner response, the plaque lesions disappear as the skin heals.
What is cryotherapy?
Cryotherapy is inexpensive and does not require anesthesia or an operating room. The treatment itself takes only a few seconds to perform and is rarely painful. No sutures or special dressings are required after the procedure. For some conditions, only one application is necessary to see benefit. The use of cryotherapy is well-documented in treating abnormal skin cells such as skin tags, warts, and some cancers. There has been increased interest in using cryotherapy to treat psoriasis plaques, however evidence of its efficacy is limited.
What does the research say?
One study demonstrated that cryotherapy may be an effective treatment for small plaques of psoriasis when compared to placebo; however, this study is not conclusive.1 The small sample size study makes it difficult to generalize the findings, but the limited data available is hopeful. Of the nine people in the study, just over half had full-resolution of the plaque at the treated site, and only one person had no improvement.1
These responses are similar to an earlier, larger study by Scoggins which enrolled 35 subjects and showed response rates of 67-80% to cryotherapy applied to psoriasis plaques.2 The treatment is not without side effects, however. In the 1997 study, of the five people with complete resolution, three developed hypopigmentation (loss of skin pigmentation), atrophy (skin thinning), or a mild infection at the site of treatment. These side effects were only apparent in the sites with complete resolution, suggesting that longer duration of treatment is both more effective but also more risky.2
More recently in 2005 a larger study enrolled 63 participants and used a more aggressive treatment protocol. The plaques were treated with liquid nitrogen every other day for two weeks.3 Four participants had complete resolution, 19 had mild to moderate improvement, and 40 participants had no improvement. Only one person developed side effects from the treatment (infection). The best treatment response was seen in older patients and patients with larger lesions. This study demonstrated similar mixed results as prior research, and overall had a lower rate of treatment response than the earlier smaller studies discussed above.3
In all these studies, the placebo conditions were plaques of similar size and severity located on the participants who were being treated.
What is the verdict on cryotherapy for psoriasis?
Though there is not robust evidence that cryotherapy is completely effective in treating small-plaque psoriasis, there is adequate evidence that it can be effective in some cases and is generally a well-tolerated, low-risk treatment. As with any treatment, individuals who are considering pursuing cryotherapy should speak with their health care providers to discuss the individual risks and benefits.
Nouri K, Chartier TK, Eaglstein WH, et al. Cryotherapy for psoriasis. Arch Dermatol. 1997;133(12). https://jamanetwork.com/journals/jamadermatology/article-abstract/559597. Accessed May 12, 2018.
Scoggins RB. Cryotherapy of Psoriasis. Arch Dermatol. 1987;123(4):427–428. doi:10.1001/archderm.1987.01660280027011
Shamsadini S, Varesvazirian M, and Shamsadini A. Cryotherapy as a treatment for psoriasis. Dermatology Online Journal. 2005;11(2). https://escholarship.org/uc/item/267351sg. Accessed May 11, 2018.