Atopic Dermatitis

Shuang Liang et al. (2024) · BMJ open

This systematic review and meta-analysis pooled 8 randomized controlled trials with 463 participants (229 receiving acupuncture, 234 receiving a comparator) to test acupuncture for atopic dermatitis — also called atopic eczema — a chronic, relapsing inflammatory skin condition marked by itch (pruritus), dryness and rash. The most frequently needled points were LI11 (Quchi), ST36 (Zusanli) and SP10 (Xuehai), acupoints from Traditional Chinese Medicine's meridian system traditionally used to clear heat, calm itch and support immune balance; here they were tested against blank controls, sham (non-penetrating) acupuncture, or standard medicines like antihistamines and topical steroids. Across the eight trials — two from Germany, two from South Korea and four from China — treatment took two main forms: manual acupuncture (5 trials, mostly needling LI11, ST36 and SP10 for 15-30 minutes, one to seven times weekly over 10 days to 5 weeks) and fire acupuncture, where a heated needle is briefly inserted (3 trials, mainly paired with standard medicine). Two trials added retained press-tack needles at LI11 and the ear point Shenmen. Severity was tracked with the SCORAD index (combining physician and patient ratings) and the EASI (physician-only); itch with a 0-100 visual analogue scale (VAS); and quality of life with the DLQI questionnaire. Acupuncture significantly lowered SCORAD scores compared with control (MD=-10.61, 95% CI -17.77 to -3.45, p=0.004 — a drop large enough to clear the 8.7-point threshold doctors consider clinically noticeable). It cut itch scores even more clearly (VAS MD=-14.71, 95% CI -18.20 to -11.22, p<0.00001 — also above its meaningful-change threshold) and improved DLQI quality-of-life scores (MD=-2.37, p<0.0001), though that change fell short of the threshold considered clinically important. The EASI score, which relies only on a physician's rating rather than patient-reported itch and sleep, showed no significant group difference (p=0.08), and neither did blood IgE levels (p=0.07). Compared specifically with sham (fake-point) acupuncture rather than no treatment, real acupuncture still won out on SCORAD (p<0.00001) — evidence the effect is not just expectation or attention. Only mild, short-lived side effects were reported (bruising, limb numbness, mild stomach upset), and no serious harms occurred in any of the five trials that tracked safety. In atopic dermatitis, these results suggest acupuncture — especially manual or fire acupuncture at LI11, ST36 and SP10 — may help as an add-on to standard treatment, with itch relief the most consistent benefit and a good safety record. The review authors caution that only 8 small trials (463 people total) were available, most had weaknesses like unclear allocation concealment or blinding, and results varied a great deal between studies. Larger, more rigorously blinded multicentre trials are needed before acupuncture earns a stronger recommendation than a promising adjunct therapy.