What is Cold Therapy?

Cold therapy is the usage of low temperatures to treat a medical condition. It is commonly used to treat abnormal, damaged tissue, lesions, and skin diseases. (1) The temperature recommended for Cold therapy typically starts at 15℃.
Cold therapy has been used by many people with topical steroid withdrawal in attempts to relieve the inflammation and itch associated with Red Skin Syndrome. According to 12one study, cold therapy has special anti-inflammatory effects experienced by sufferers of skin conditions like atopic dermatitis.
Cold therapy is often referred to as only temporary relief from inflammation, however studies support the ongoing beneficial effects of cold therapy to continue after the cold exposure is gone. (1)

Different Types of Cold Therapy and Their Benefits

The method of application, duration, and site of application are key factors that influence the effectiveness of the treatment method and the comfort of the patient.

1. Ice Packs

These are perhaps the most accessible kind of cold therapy. Different kinds of ice packs include single-use chemical ice packs suitable for outdoor use, the reusable cold compress, and the regular pack of frozen peas that some use at home. Ice packs have been used for inflammation for decades and are often supportive treatments for athletes. People predisposed to atopic dermatitis often utilize ice packs as a method to reduce itching, redness and inflammation of the skin.

ice packs for topical steroid withdrawal

2. Ice Baths

This may be a cold shower or a soak in a freezing tub of ice water. An ice bath is said to do wonders for inflamed skin and improve mental health. Ice bath enthusiasts advocate mental clarity and cognitive benefits after each ice bath. After submerging in cold water for minutes, the risk of catching a cold is often said to decrease, due to a boost of the immune system. It is recommended not to soak for more than 10 minutes at a time.

3. Cryocuffs

Cryocuffs target at specific areas such as the knee, upper arm, calf, or ankle. It delivers a cooling effect without the wetness of an ice bath or an ice bag. In a cryo cuff, the cuff arm is attached to a cooling bucket that contains ice. The ice serves to repeatedly cool the content of the cuff, maintaining a steady temperature gradient.

4. Cold Sprays

Cold sprays come in pressurized cans that are dry and mobile, ideal for convience of use. Advanced preparation of the cold spray is a device called a Cryo gun. It is used in medical facilities to eliminate tumor cells and potential cancers. It is used to treat benign and pre-malignant tumors. It effectively destroys cancer cells at sub-zero temperatures.

5. Cryotherapy machines

Cryotherapy machines, also known as cryotherapy saunas, are machines intended to deliver a cooling effect to the whole body in one session. They are powered by pressurized or nonpressurized liquid nitrogen at temperatures below the freezing point of water (typically -195.79℃). This low temperature is distributed within an adequately ventilated system. The oxygen content of the environment is of primary importance. Oxygen prevents discomfort and the rare loss of consciousness.
Cryotherapy machines may come built with soft cushioning for extra comfort, safety devices, wireless controls, and even audio-visual content.

6. Wim Hof method

The Wim Hof Method (WHM) is a combination of physical and mental therapy. It stands on three pillars; cryotherapy, mindfulness, and breathing. The WHM involves stages of meditation, deep breathing, and then submerging into an ice bath. The participant is encouraged to start small, with a few minutes each, progressing into more extended periods and lower temperatures as ones advances within the process. (2)
The WMF method yields excellent benefits for the mind and body. Aside from pain relief from soreness and inflammation, it is known to reduce mental stress, encourage weight loss, and improve clarity. The Wim Hof Method has been become a booming trend for people with different types of inflammation and in recent times, commonly used as a method to reduce inflammation during topical steroid withdrawal.

 

Cold Therapy Benefits for Topical Steroid Withdrawal

Currently, there is no universally accepted treatment for Topical Steroid Withdrawal. Studies suggest pulse therapy, nerve-calming agents such as cold therapy, and moisturizers towards managing the condition and discomfort, however there is no medical solution for Topical Steroid Withdrawal.
The benefits of a cold compress against inflamed skin have long been identified, but only recently has it been included in the management therapy for Topical Steroid Withdrawal. For a condition as unprecedented as this, it is difficult to ascertain the extent of the effectiveness of cold therapy for this new iatrogenic phenomena.

How Cold Therapy May Help Managing The Symptoms of Topical Steroid Withdrawal

Submerging in ice-cold water to relieve pain is almost instinctive. This practice dates back to the Egyptian and Greek empires. Recent studies support cold therapy in the reduction of pain and inflammation. (3)
The action of lowered temperature on skin disorders may take any of the following pathways.

1. Inflammation

Cold therapy influences the inflammatory process through direct and indirect means. At first, the low temperature causes the local blood vessels to shrink or constrict instead of dilating. This movement discourages the migration of large-sized leukocytes (4). The inflammation process involves the pooling of heat towards the site of interest. By intercepting this, cold therapy halts the inflammatory process and prevents the transmission of signals. The constriction of local blood vessels canl reduce the redness associated with TSW and prevent the release of inflammatory hormones, bradykinins, and prostaglandins that stimulate pain. (5)
Cold therapy also has a relationship during the thermoregulation back to warmth after the cold exposure. When the cold sensation is withdrawn and blood vessels allowed to dilate, an anti-inflammatory cytokine, Interleukin-10, is released, preventing further pain and soreness. This is seen to a more considerable extent with cryotherapy chambers when compared to ice packs and cold showers.

2. Skin Health

Cold therapy proves effective in the reduction of skin lesions. In one study, a combination of an antibiotic and cryotherapy gave a quicker therapeutic effect than the use of the antibiotic alone (Metronidazole cream). (6)
In this study, cryotherapy was used as an adjunct in the treatment of Demodicosis, a chronic skin disorder often coupled with erythematosquamous inflammation. Cold therapy is also said to yield excellent cosmetic results. Proponents have reported fading of wrinkles with regular use of ice packs.
More evidence proposes that cold therapy may be helpful in treating skin cancers. One study showed a 97% cure rate for non-melanoma skin cancers with cryotherapy. Unfortunately, relapses were noticed 6-24 months after the cryotherapy session (7). However, comparing the pain relief, cosmetic benefits, and low cost of cryotherapy, it was deemed safe and effective in managing skin cancers, if only temporarily.

3. Chronic Pain

Topical Steroid Withdrawal is commonly associated with intense pain and a burning sensation on the skin. Cryotherapy may be an alternative to oral and topical analgesic agents. As cold therapy is commonly related to joint pain and inflammation, studies show that the analgesic benefits of cold therapy can be just as beneficial on sensitive skin than on bones and joints. In a particular study, patients treated with cold therapy following a craniotomy reported that the pain relief was tremendous around the eyelids and midfacial region than the cranial region. (8)
Cryotherapy as a whole was able to relieve post-surgical discomfort edema and lessen the frequency of headaches.

 

More Relevant Benefits of Cold Therapy

1. Treatment of Atopic Dermatitis (AD)

Whole-body cryotherapy is relatively effective in the management of AD. (9)

2. Immunity

Cryotherapy influences the immune system, promoting the release of anti-inflammatory cytokines.(10)

3. Weight Loss

Cryotherapy may control obesity either by cold-induced thermogenesis or adipose disruption. Cold therapy stimulates the breakdown of stored fat. (11)

 

Conclusion

There is no current cure for topical steroid withdrawal, however cold therapy is a common solution used in managing the inflammation associated with the symptoms of topical steroid withdrawal. Cold therapy can assist in the alleviation of pain, redness, and discomfort associated with Topical Steroid Withdrawal. Ice packs, cold showers and ice baths are the most common forms of cold therapy used.

 

References

  1. https://en.wikipedia.org/wiki/Cryotherapy
  2. https://www.wimhofmethod.com/cryotherapy
  3. https://activeclinics.co.uk/cryotherapy-offers-relief-for-topical-steroid-withdrawal-tsw-sufferer/
  4. https://link.springer.com/article/10.1007/s00421-013-2693-9
  5. https://europepmc.org/article/med/7468403
  6. https://europepmc.org/article/med/19556638
  7. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.1988.tb03205.x
  8. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2702.2008.02652.x
  9. https://jamanetwork.com/journals/jamadermatology/fullarticle/419737
  10. https://cancerres.aacrjournals.org/content/74/19/5409.short
  11. https://www.hindawi.com/journals/jobe/2018/5789647/
  12. https://www.hindawi.com/journals/mi/2019/1936769/
IMPORTANT
This information should not be taken as medical advice nor replace any medical treatment and advice from your doctor. There are many complexities involved in topical steroid withdrawal. Time is the biggest factor for healing topical steroid withdrawal. The solutions on this website are suggested to help mitigate the inflammation, pain and suffering during the withdrawal period, but not cure topical steroid withdrawal. Currently there is no medical cure for topical steroid withdrawal.