Volume 29, Number 5, 2017

Acupuncture and Cutaneous Medicine:

Is It Effective?

Background: In China, acupuncture has been used as a form of medical therapy for more than 2500 years. It

is a part of traditional medical practice and is used to treat the entire spectrum of human and veterinary

disease. Although dermatologic disease has received much less attention in worldwide acupuncture research

than pain and musculoskeletal conditions, there is a growing body of evidence suggesting acupuncture’s

usefulness in this area.

Objective: The aim of this article was to review the evidence in the literature regarding the usefulness of

acupuncture in managing dermatologic illness.

Results: Trials and case reports of patients using acupuncture have been published in the areas of atopic

dermatitis and urticaria, herpes zoster, psoriasis, acne, melasma, and hyperhidrosis, as well as in promoting

wound healing. Itch modulation by acupuncture has been the focus of recent research as itch is a predominant

symptom in allergic skin diseases and leads to serious impairment of quality of life.

Conclusions: Although more research is needed, acupuncture’s use in cutaneous medicine is promising in

the area of itch modulation, in treating atopic dermatitis and herpes zoster pain, and in promoting wound


Keywords: dermatologi

Mary van den Berg-Wolf and Thomas Burgoon


Acupuncture compared to oral antihistamine for type I

hypersensitivity itch and skin response in adults with atopic

dermatitis – a patient and examiner blinded, randomized,

placebo-controlled, crossover trial

Background—Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been

shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture

and anti-histamine itch therapy (cetirizine) on type-I-hypersensitivity itch and skin reaction in AD

using a patient and examiner blinded, randomized, placebo-controlled, crossover trial.

Methods—Allergen–induced itch was evaluated in 20 AD patients after several interventions in

separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and

VAa), cetirizine (10mg, VC), corresponding placebo interventions (preventive, PAp, and abortive,

PAa, placebo acupuncture; placebo cetirizine pill, PC), and a no-intervention control (NI). Itch

was induced on the forearm and temperature modulated over 20 minutes, using our validated

model. Outcome parameters included itch intensity, wheal and flare size, and the D2 Attention


Results—Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9)

compared to all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7,

p<0.05). There was no significant difference between VAp and VC (p>0.1), though both therapies

were significantly superior to their respective placebo interventions (p<0.05). Flare size following

VAp was significantly smaller (p=0.034) than PAp. D2 attention test score was significantly lower

following VC compared to all other groups (p<0.001).

Conclusions—Both VA and cetirizine significantly reduced type-I-hypersensitivity itch in AD

patients, compared to both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially due to counter-irritation and/or distraction.

Itch reduction following cetirizine coincided with reduced attention.

Florin Pfab et al.


The Brain Circuitry Mediating Antipruritic Effects of Acupuncture

Itch is an aversive sensory experience and while systemic therapies,

such as acupuncture, have shown promise in alleviating itch

in patients suffering from chronic itch, their antipruritic mechanisms

are unknown. As several lines of evidence implicate brainfocused

mechanisms, we applied functional magnetic resonance

imaging and our validated temperature-modulation itch model to

evaluate the underlying brain circuitry supporting allergen-induced

itch reduction in atopic dermatitis patients by acupuncture, antihistamine,

and respective placebo treatments. Brain response to allergen

itch demonstrated phase dependency. During an increasing itch

phase, activation was localized in anterior insula and striatum,

regions associated with salience/interoception and motivation processing.

Once itch reached peak plateau, robust activation was

noted in prefrontal cognitive and premotor areas. Acupuncture

reduced itch and itch-evoked activation in the insula, putamen, and

premotor and prefrontal cortical areas. Neither itch sensation nor

itch-evoked brain response was altered following antihistamine or

placebo acupuncture. Greater itch reduction following acupuncture

was associated with greater reduction in putamen response, a

region implicated in motivation and habitual behavior underlying the

urge to scratch, specifically implicating this region in acupuncture’s

antipruritic effects. Understanding brain circuitry underlying itch

reduction following acupuncture and related neuromodulatory therapies

will significantly impact the development and applicability of

novel therapies to reduce an itch.

Vitaly Napadow et al.