Stimulated by Jiao et al 2019.
Over the 25 plus years that I have been using acupuncture techniques, I have treated very few patients for eczema or eczema-related symptoms. In the early days, when I took on an existing practice from Adrian White, I was presented with a number of patients with conditions for which I would never have thought to use acupuncture. I remember a young adult woman, brunette, possibly airline cabin crew, who had a rather mild chronic rash. It may have been either eczema or psoriasis. I remember treating her for several sessions, and I was probably being nice and thinking I am just going to use some recommended points and hope for the best. She was very satisfied at the end of the treatment course, which I found curious as from my perspective, since the rash was entirely unchanged as far as I could tell.
So when this paper was published online in Acupuncture in Medicine on the 9th September 2019, I thought it was an opportunity to revisit an area of profound ambivalence for me!
This systematic review includes 434 participants, 424 of whom were from China and 10 were from Germany. The Chinese studies compare acupuncture with drugs, and the meta-analysis of this comparison favoured acupuncture in terms of the eczema area and severity index (EASI), and global symptom improvement.
That being said, my experience from years ago was not convincing, and it is certainly possible for patients to feel better without any objective change in disease severity.
I started to consider whether or not I should try again with skins!
So I looked at the protocols used…
I was of course happy to see ST36 figure highly along with LI11, SP6 and SP10. But I was surprised to see ah shi points in the area of the rash mentioned in all the Chinese studies.
Then I noticed that the needling was anything but normal from a Western perspective. All the Chinese studies used fire needling!
Any of you who have not experienced fire needling, you need to try it. I have had it once, and it involved about 30mm of white hot metal being thrust into the soft tissues of my hip, just above my left greater trochanter. I remember hearing a tssss sound and feeling a deep somatic sensation, but only for a few seconds. Of course the heat capacity of a needle is rather small in comparison to that of saline-filled human tissues. My hip was noticeably less troublesome for a good couple of weeks – I have some mild chronic degenerative hip pain on the side I offered for treatment. I was quite impressed as I generally consider myself a non-responder.
That was a rather deeper version of fire needling than is common. Most techniques I have seen only heat the needle tips and the insertion is relatively superficial, and the tssss sound is less noticeable.
Fire needling to points around the rash will create lots of micro burns in the skin, which will presumably distract from any adverse sensations from the rash. They may set up some local activity that has other effects than distraction, but I am not aware of much research looking at mechanisms of fire needling.
Then I noticed that most of the Chinese studies used treatment three times per week over three to eight weeks.
This sort of pragmatic unblinded data naturally acquires the label of high risk of bias and low or very low GRADE evidence. Acupuncture is hard enough to blind, imagine trying to find a placebo for fire needling! In these Chinese studies the acupuncture has been tested against steroids and antihistamines.
In conclusion, it seems unlikely that I will be trying this technique in the hospital outpatient’s department, but it may prove useful in interacting with commissioners, managers and selected colleagues (I am joking of course!).
1 Jiao R, Yang Z, Wang Y, et al. The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis. Acupunct Med Published Online First: 9 September 2019. doi:10.1177/0964528419871058