Skin necrosis (death of skin and tissue) is a complication of using a cold therapy machine improperly. Although the manufacturers of these devices claim they can be used for “continuous cold therapy” for up to 11 hours, experts recommend against using them for more than 20-30 minutes or below 59º F due to the risk of skin necrosis.

Overview: Skin Necrosis

Skin necrosis is a severe medical condition that occurs when a large number of cells in the skin die. Necrosis can involve only the uppermost layers of skin (epidermis), deep layers (dermis), fatty subcutaneous layers, and even structures under the skin including nerves, muscles, ligaments, and more.

Skin necrosis is an irreversible medical condition that is usually treated with debridement (surgical removal of the skin) and skin grafts (transplantation of healthy skin from another area of the body).

Cold Therapy and Skin Necrosis

Many people who use cold therapy machines do not realize the danger of exposing their body to prolonged cold temperatures. The largest machines can run continuously for up to 11 hours, pumping ice-cold water into a compression pad that the patient is supposed to wrap tightly around their injured body part.

Unfortunately, many people falsely believe that cold therapy is safe when it is above freezing. Actually, the beneficial effects of cooling end at 15ºC (59ºF). Furthermore, slow and prolonged cooling is more destructive than fast cooling (for example, with an ice pack changed every 10 minutes) because major intra- and extracellular ion and protein shifts can cause devastating skin damage, skin necrosis, nerve damage, and tissue damage.

Furthermore, although manufacturers of cold therapy machines claim their products are superior to traditional ice packs, they do not warn about the additional risk of skin necrosis from excessive cooling.

Case Reports of Skin Necrosis from Cold Therapy

In January 2007, Orthopedics published a case report describing severe skin necrosis caused by a cold therapy machine: Severe Frostbite of the Knees After Cryotherapy (GRAPHIC).

The surgeons who published the report recommended taking the following steps to minimize the risk of frostbite, skin necrosis, and other injuries:

“Current recommendations for cryotherapy include 20-30 minutes of cryotherapy with a maximum time of 40 minutes, always with a protective covering (usually a towel) between the cryotherapy wrap and the skin. The cycle can be repeated every 2 hours while the patient is awake.”

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