Rethinking cryotherapy: A case for reappraisal across dermatologic indications

Cryotherapy has historically occupied a prominent position in Indian dermatology practice, supported by national guidelines published in 2009. This viewpoint argues that cryotherapy deserves a fresh look in Indian dermatology. Its role may be less secure than we assume, not only for routine benign lesions but also for indications where it has traditionally been considered useful, such as anogenital warts, pediatric lesions, and keloid management. The fundamental limitations of cryotherapy include blind tissue destruction, unpredictable depth of injury, multiple sessions, and poor tolerability in darker skin types. This argument for preferentially using radiofrequency (RF) is based mainly on clinical reasoning and experience, since direct comparative trials between RF and cryotherapy for these indications are still lacking. Such studies are clearly needed. Ultimately, the choice between these modalities is not only a clinical one – it is an ethical one. Cryotherapy became popular because it is quick, simple, and requires little infrastructure; however, these advantages do not necessarily make it the best option for the patient in an equipped dermatology office. Where RF is available, a single procedure performed under local anesthesia, with controlled analgesia and possible single-sitting clearance, may be preferable from the patient’s perspective. Each traditional indication for cryotherapy should therefore be reassessed in the Indian office setting, rather than retained simply because it has long been part of routine practice.