What is the introduction of cryotherapy?

Dec. 09, 2024

History of cryotherapy - eScholarship

History of cryotherapy
Anatoli Freiman MD and Nathaniel Bouganim MD
Dermatology Online Journal 11 (2): 9

Division of Dermatology, McGill University Health Centre, Montreal, Canada.

Abstract

Cryotherapy refers to the use of cold temperature to treat disease and is a mainstay therapeutic modality for a wide variety of skin conditions. This article reviews the early history of development of cryotherapy in dermatology.

You will get efficient and thoughtful service from Rejuvelab.

The Egyptians used cold to treat injuries and inflammation as early as BCE. Dominique-Jean Larrey, Napoleon's legendary surgeon, used it to facilitate amputations during historic retreat from Moscow [1]. Between and , Dr. James Arnott of Brighton, England, described the benefits of local cold application in the treatment of numerous conditions, including headaches and neuralgia. Arnott used salt solutions containing crushed ice at a temperature of -18° to -24°C to freeze breast, cervical, and skin cancers; he observed shrinking of the tumors and significant decrease in pain [2]. He went on to design an apparatus for the application of cold that was shown at the Great Exhibition in London in [3]. However, the device was cumbersome to use, had little freezing capability, and had limited applicability. In addition, Arnott recognized the analgesic benumbing effect of cold, recommending its use to anesthetize the skin before surgery [2, 3, 4].

In Cailletet of France and Picet of Switzerland began development of an expansion system for cooling gases [5, 6]. In James Dewar of Great Britain designed the first vacuum flask, which facilitated storage and handling of liquefied gases. Von Linde of Germany went on to establish commercial liquefaction of air in - [7]. The first clinical application of liquid air (-190°C) was in by a New York City physician, Campbell White, who used either a swab, a spray, or a brass roller device. He reported the use of liquid air for the treatment of diverse skin conditions, including lupus erythematosus, herpes zoster, chancroid, warts, and epitheliomas [8, 9]. In , Whitehouse, also from New York, reported a series of fifteen skin cancers treated with cryotherapy with good results. He described the use of a spray bottle, although he found this technique difficult and stopped using it in favor of a cotton swab [10].

Solidified carbon dioxide (-78.5°C) was introduced into clinical use by Dr. William Pusey of Chicago. He favored the use of solid carbon dioxide, which was commonly used as a refrigerant at the time and could be obtained where soda-fountain supplies were sold. Pusey treated warts, vascular nevi, lupus erythematosus, lupus vulgaris, and epitheliomas [11]. Further to these initial reports, many physicians made use of the freezing techniques in dermatology. After , liquid air was seldom used, and solid carbon dioxide was the most popular cryogenic agent in the early s.

Liquid oxygen (-182.9°C) came into clinical use in the s. Irving and Turnacliff described good results with warts, lichen planus, and other skin conditions. Though it was readily available in the following years, liquid oxygen was hazardous because it was combustible [12]. In Kile and Welsh wrote one of the last reports on the use of liquid oxygen in a case series of over 1,000 patients with a variety of noncancerous diseases and mucosal diseases, including warts, hemangiomas, keratoses and leukoplakia [13].

Following World War II, liquid nitrogen (-196°C) became commercially available. In this cryogen was introduced into clinical practice by Dr. Ray Allington, who described the technique of using cotton swabs dipped in liquid nitrogen for the treatment of a variety of nonneoplastic skin diseases. Subsequently, this method became common practice for the treatment of verrucae, keratoses, and diverse other nonneoplastic lesions [14].

Modern cryosurgery began through the collaborative work of a physician, Irving Cooper, and an engineer, Arnold Lee [15]. They built a cryosurgical probe that became the prototype from which every subsequent liquid nitrogen cryosurgical probe was built. Made of three long concentric tubes, the probe was supplied with liquid nitrogen from a pressurized source. The inner tube served as a conduit for liquid nitrogen flow to the tip of the probe, while the space between the inner tube and the middle tube provided a path for the return of gaseous nitrogen from the tip of the probe. The space between the outer tube and the middle tube was vacuum insulated and had a radiative shield, allowing the liquid nitrogen to be conducted without heat loss to the tip of the probe [15].

Between and , other cryosurgical apparatuses were developed using liquid nitrogen and other cryogenic agents, including nitrous oxide, carbon dioxide, argon, ethyl chloride, and fluorinated hydrocarbons [16]. Douglas Torre, a dermatologist, used Cooper's apparatus for skin diseases, developing a nitrogen spray device that could also be used with cryoprobe tips of various shapes and sizes, converting the conduit line to a closed system in [17]. In addition to benign lesions, Torre treated many types of basal and squamous cell carcinomas with cryosurgery. In Setrag Zacarian introduced a hand-held self-pressurized device [18]. Working with an engineer, Michael Bryne, he reported the development and use of a handheld spray device using liquid nitrogen in . After some modifications, this became the first commercially available handheld cryosurgical device. Zacarian published his research and clinical data in a monograph and in two subsequent books [19, 20]. In Torre, Lubritz, and Kuflik coauthored a book on the practical aspects of cryosurgery in dermatology [21]. Over the recent years, cryotherapy has become a well-established treatment modality for a wide variety of benign and malignant skin lesions, with novel uses continually described.

References

1. Larrey, DJ. Memoires de chirugie militaire et compagnies. Philadelphia: Carey & Lea, ; -7.

2. Arnott J. Practical illustrations of the remedial efficacy of a very low or anaesthetic temperature. I. In cancer. Lancet ; 2: 257-259.

3. Bird H, Arnott J. A pioneer in refrigeration. Anaesthesia ;4:10-17.

4. Arnott J. On the treatment of cancer by the regulated application of an anesthetic temperature. London: J. Churchill, .

5. Cailletet L. Recherches sur la liquefaction des gaz. Ann Chemie Physique. , 15 :132-44.

6. Pictet R. Memoire sur la liquefaction de lëoxygen. Ann Chemie Physique. , 15 :145-47.

7. Hall-Edwards J. Carbon dioxide snow: its therapeutic uses. London: Simpkin, Marshall, Hamilton, Kent, .

8. White AC. Liquid air: its application in medicine and surgery. Med. Rec. ;56: 109-12

9. White AC. Possibilities of liquid air to the physican. JAMA ; 198:426-28.

10. Whitehouse H. Liquid air in dermatology; its indications and limitations. JAMA ; 49:371-77.

11. Pusey WA. The use of carbon dioxide snow in the treatment of nevi and other lesions of the skin. J Am Med Assoc ; 49:-.

12. Irvine HG, Turnacliff DD. Liquid oxygen in dermatology. Arch Dermatol Syph ; 19:270-280.

13. Kile RL, Welsh AL. Liquid oxygen in dermatologic practice. Arch Dermatol Syph ; 57:57-60.

14. Allington HV. Liquid nitrogen in the treatment of skin diseases. Calif Med ; 72:153-155.

15. Cooper I, Lee A. Cryostatic congelation: a system for producing a limited controlled region of cooling or freezing of biological tissue. J. Nerv. Ment. Dis. ;133: 259-63.

16. Torre D. Alternate cryogens for cryosurgery. J Dermatol Surg ; 1:56-58.

17. Torre D. Cutaneous cryosurgery. J Cryosurg ; 1:202-209.

18. Zacarian SA (ed). Cryosurgery of skin cancer and cryogenic techniques in dermatology Springfield, IL: Charles C. Thomas, .

19. Zacarian SA. Cryosurgery of tumors of the skin and oral cavity. Springfield, IL: Charles C. Thomas, .

20. Zacarian SA. Cryosurgical advances in dermatology and tumors of the head and neck. Springfield, IL: Charles C. Thomas, .

21. Torre D, Lubritz RR, Kuflik EG. Practical cutaneous cryosurgery. Norwalk, CT: Appleton & Lange, .

Cryotherapy: History and Methodology

By Brooke Simon, DVM
angell.org/dermatology

617-524-

History of Cryotherapy

The company is the world’s best Cryotherapy Chamber supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.

Cryotherapy and cryosurgery date back to the 19th century, with local applications of cooling used for pain control and to treat advanced cancers. However the use of cold to treat different injuries and inflammation dates back to ancient Egyptians in BCE.

The development of vacuum flasks to help facilitate storage of liquefied gases further progressed the process of cryotherapy, eventually leading to liquid carbon dioxide (-78.5&#;) being used in the early &#;s by Lortat-Jacobs and Solente in Paris to treat skin lesions and gynecological lesions. While this proved effective to treat these lesions, the adhesion of the applicator tip to the tissue and difficulty of removal lead to exploration of additional methods. This lead to liquid oxygen (-182.9&#;) being developed with good results in treatment of dermatologic conditions, although its highly combustible nature limited its use.

Liquid nitrogen (-196&#;) first became available after World War II, when in Dr. Ray Allington used cotton swabs dipped in liquid nitrogen to treat various types of non-neoplastic skin disease.

The more modern approach of cryosurgery began between the collaboration of a physician, Dr. Irving Cooper, and an engineer, Arnold Lee. Their development of a cryosurgical probe has been the basic model for all subsequent cryosurgical probe models. The more commonly used nitrogen spray device used today was developed by dermatologist Dr. Douglas Torre in , and further modified to a handheld spray device using liquid nitrogen in by Dr. Setrag Zacarian.

Freezing/Thawing Effects

Freezing of tissue has been extensively researched, with a few hypotheses on how freezing results in cell destruction and death. The primary theory involves direct cellular injury from the extracellular space, as a result of high concentrations of extracellular ice causing cell dehydration. This occurs through two mechanisms: slow cooling rates resulting in freezing in the extracellular space causing the cells to dehydrate themselves through osmosis, and membrane destabilization during the freezing and thawing cycles.

An additional mechanism likely involves intracellular ice formation, causing disruption of the organelles within the cell as well as the membrane of the cell. A second theory involves an immunological response to freezing, with the immune system becoming reactive to destroyed frozen tissue, which then results in the immune system reacting to any remaining residual tissue. The final theory suggests that damage to the blood vessels of the lesion through freezing results in loss of blood flow, leading to tissue damage and death.

Thawing of these lesions has varying effects, but they are determinate on the cooling rate. Slow thawing after cryotherapy is performed allows for the maximum amount of ice to form, thereby causing the greatest effects on the cells. Completely thawing the lesion before re-freezing is essential, as this creates further ice formation and allows for recrystallization of the ice crystals. Recrystallization within cells occurs when smaller crystals thaw, then form larger and larger crystals over time and eventually result in punctures to the cell membrane. Rapid cooling and rapid thawing, however, has also proven to be effective, by creating smaller ice crystals within the cells. This then allows for further recrystallization.

The degree of cellular injury does vary in in-vivo situations: cells in tumor tissue along the skin will have varying levels of freezing effects due to the size of the lesion and vascularity changes. Types of cells involved, exposure to air, or state of malignancy will also affect freezing time and effectiveness. Previous studies have shown cells near the center of the probe experience the lowest temperature and fastest cooling rates, whereas the tissue along the outer edge of the lesion typically has near-normal body temperature.

Cryotherapy at Angell

Within the Dermatology Service at Angell Animal Medical Center, we offer cryotherapy for superficial masses along the skin as a non-anesthesia option of mass removal. While not all superficial masses can be removed via cryotherapy due to location or size, many external masses such as sebaceous adenomas or viral papillomas respond very well to cryotherapy freezing. Any questions regarding referral for cryotherapy can be directed to our Dermatology service at .

References

For more information, please visit Electric Cryotherapy Chamber For Sale.

Cryosurgery: A review. Yiu, W et al. Int J Angiol. Spring; 16(1): 1-6
History of Cryotherapy. Freiman, A et al. Dermatology Online Journal. ; 11(2): 9
The Haemolysis of human red blood-cells by freezing and thawing. Lovelock, JE. Biochim Biophys Acta. Mar; 10(3): 414-23.
Role of Plasma Membrane in Freezing Injury and Cold Acclimation. Ann Rev Plant Phsiol. ; 35: 543-84.