Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Research and Resources on Eczema, Psoriasis, Dermatitis, Pruritus (itching) and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “psoriasis” yields over 9,200 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 701 results; of which 38% have been carried out since 2017 (Google Scholar). A scholarly search of the available research papers on the terms “acupuncture” + “eczema” yields over 8,300 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 719 results; of which 32% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in both these areas, leading to a growing body of research, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Yeh et al’s (2017) systematic review of 13 RCT’s (n=1060) concluded that acupuncture techniques could be considered as an adjuvant therapy in this field, and in particular acupressure and catgut embedding, noting limitation in methodological quality of some studies and calling for more rigorous trials to be carried out (note: catgut embedding is not generally used in the UK).
Since then, and having seen an increase in the pace of research in this area in the last 4 years, the forthcoming systematic review of Cheng at al, (protocol: 2021) may add to the understanding of this area of research. Xiao et al have also put forth a protocol for a systematic review to compare herbal medicine along with and acupuncture + herbal medicine for psoriasis, which will be of interest (protocol: Xiao et al, 2019). As far as forthcoming reviews in acupuncture adjunctive techniques, Zou et al’s systematic review of moxibustion therapy for psoriasis (protocol: Zou et al, 2021), and Zhang et al’s (protocol: 2020a) systematic review for cupping for psoriasis will be of interest when published.
The results of a small (n=10), randomised controlled trial (Pfab et al, 2011), suggested acupuncture reduced itch intensity and the expression of certain immune factors (basophils) in patients with atopic eczema. The acupuncture group showed less CD63 positive basophils (allergy markers in the body) and rated mean itch intensity significantly lower than did the control group after exposure to allergens (house dust mite and timothy grass pollen). Pfab et al 2010 (n=30) had also found that after an allergen stimulus (house mite or grass pollen skin prick), the size of the wheal and flare at the skin site were smaller in the group receiving preventative acupuncture than in the control (no acupuncture) and placebo (non-specific acupuncture points used) groups, suggesting that the actual points used are also relevant and not just the overall action of needling. Mean itch ratings were also lower once again in the true acupuncture group.
A systematic review (Jiao et al, 2020) looked at 8 RCT’s (n=434), and despite some methodological limitations were able to conclude acupuncture may decrease itch sensitivity and improve the global symptoms of atopic eczema.
A forthcoming systematic review protocol has been published with the aim of evaluating the efficacy and safety of acupuncture in the treatment of atopic dermatitis (protocol: Lee et al, 2019). This is another growing research area, of 451 RCT’s ever published on this, 180 have been carried out since 2017.
More generally, for chronic pruritus, a condition of chronic itching that can be caused by different disease states and which adversely affects quality of life, a systematic review is awaited, the protocol having been published in the BMJ Open recently (protocol: Zhang et al, 2020b).
Mechanisms of Action:
A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines. The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”.
Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.
Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:
- Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
- Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
- Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.
In an animal model study, acupuncture treatment was shown to inhibit swelling of the ears and ear weight in mice with oxazolone-induced skin allergic dermatitis, compared to non-acupuncture treatment (Pkumura et al, 2002), and lower levels of inflammatory markers (serum and ear tissue cytokines) were also lowered in the acupuncture group.
McDonald et al (2013) reviewed the pathophysiology of acupuncture, as it had been shown to improve clinical outcomes by modulating immune response and reducing inflammation. Per the review of RCTs, acupuncture down-regulated Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF); showing some of the means by which the anti-inflammatory effect occurs.
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines. They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis. They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
British Acupuncture Council evidence based factsheet about Eczema & Psoriasis conditions including specific research, trials and mechanisms of action for acupuncture in this condition.
Cheng, X., Lai, J., Zhang, Y., Lin, L., Xu, D., Zhong, Z., Wu, Q. and Liu, J., 2021. Efficacy and safety of fire acupuncture for psoriasis vulgaris: A protocol of systematic review and meta-analysis of randomized clinical trials. Medicine, 100(12), p.e25038.
Xiao, S., Li, B., Feng, S., Liu, C. and Zhang, G., 2019. Acupuncture combined with herbal medicine versus herbal medicine alone for plaque psoriasis: a systematic review protocol. Annals of translational medicine, 7(6).
Yeh, M.L., Ko, S.H., Wang, M.H., Chi, C.C. and Chung, Y.C., 2017. Acupuncture-related techniques for psoriasis: a systematic review with pairwise and network meta-analyses of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 23(12), pp.930-940.
Zhang, J., Yu, Q., Peng, L., Zhang, F., Lin, W., Guo, J., Xiao, M. and Chen, M., 2020a. Cupping for psoriasis vulgaris: a protocol of systematic review and meta-analysis. Medicine, 99(20).
Zou, J., Huang, G., Hu, C., Yan, J., Zhang, F., Shi, H., Yuan, X., Fu, J. and Gong, L., 2021. Moxibustion therapy for treating psoriasis vulgaris: A protocol for systematic review and meta-analysis. Medicine, 100(12), p.e25250.
Atopic Eczema References
Jiao, R., Yang, Z., Wang, Y., Zhou, J., Zeng, Y. and Liu, Z., 2020. The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis. Acupuncture in Medicine, 38(1), pp.3-14.
Pfab, F., Huss‐Marp, J., Gatti, A., Fuqin, J., Athanasiadis, G.I., Irnich, D., Raap, U., Schober, W., Behrendt, H., Ring, J. and Darsow, U., 2010. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema–a blinded, randomized, placebo‐controlled, crossover trial. Allergy, 65(7), pp.903-910.
Pfab, F., Athanasiadis, G.I., Huss-Marp, J., Fuqin, J., Heuser, B., Cifuentes, L., Brockow, K., Schober, W., Konstantinow, A., Irnich, D. and Behrendt, H., 2011. Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema: a pilot trial. The Journal of Alternative and Complementary Medicine, 17(4), pp.309-314.
Lee, H.C. and Park, S.Y., 2019. Preliminary comparison of the efficacy and safety of needle-embedding therapy with acupuncture for atopic dermatitis patients. Evidence-Based Complementary and Alternative Medicine, 2019.
Zhang, L., Deng, Y., Yao, J., Xiao, X., Yu, S., Shi, Y., Zheng, H., Zheng, Q., Zhou, S., Cao, W. and Liu, Y., 2020b. Acupuncture for patients with chronic pruritus: protocol of a systematic review and meta-analysis. BMJ open, 10(8), p.e034784.
Mechanism of Action References:
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6: 251-7.
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8.
Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.
McDonald, J.L., Cripps, A.W., Smith, P.K., Smith, C.A., Xue, C.C. and Golianu, B., 2013. The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based Complementary and Alternative Medicine, 2013.
Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.
Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.