Scars and cicatrization

Cicatrices et cicatrisation : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆	Evidence for effectiveness and a specific effect of acupuncture
☆☆	Evidence for effectiveness of acupuncture
☆	Limited evidence for effectiveness of acupuncture
Ø	No evidence or insufficient evidence

1.1. Chmielewska 2024

Chmielewska D, Malá J, Opala-Berdzik A, Nocuń M, Dolibog P, Dolibog PT, Stania M, Kuszewski M, Kobesova A. Acupuncture and dry needling for physical therapy of scar: a systematic review. BMC Complement Med Ther. 2024 Jan 2;24(1):14. https://doi.org/10.1186/s12906-023-04301-4

Backgound	There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment.
Objective	The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture.
Methods	Search strategy: The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. Inclusion criteria: The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. Data extraction and analysis: The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results.
Results	As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous.
Conclusions	The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation.

1.2. Generic Acupuncture

1.2.1. Tuckey 2019 Ø

Tuckey C, Kohut S, Edgar DW. Efficacy of acupuncture in treating scars following tissue trauma. Scars Burn Heal. 2019. [196096]. DOI

Introduction	Anecdotally, acupuncture is used in the treatment of scar tissue in order to improve scar quality and reduce symptoms of pain and pruritus. Unlike conditions such as lower back pain, knee osteoarthritis and migraines, there are no systematic reviews to confirm treatment efficacy. This systematic literature review aims to assess the current level of evidence for the use of acupuncture for treating abnormal scars such as hypertrophic or other symptomatic scars.
Methods	: A comprehensive database search was performed followed by reviewing reference lists, grey literature databases and Google Scholar. Study quality was assessed using the Oregon CONSORT STRICTA instrument (OCSI) for clinical trials and the Joanna Briggs Institute (JBI) checklist for case reports.
Results	The search strategy discovered five case studies, one retrospective cohort study, one cohort study and three clinical trials that investigated the use of acupuncture for scars. Studies rated as low to moderate quality (26-50%) on the OCSI checklist due to lack of detailed reporting, use of non-validated outcome measures and heterogeneity of participant cohorts. Three case studies rated as moderate quality (5-6/8) and two as low quality (<2/8) on the JBI checklist.
Discussion	All studies reported positive outcomes for the use of acupuncture for scar symptoms; however, treatment frequency, duration, number of treatments and points used varied between studies.
Conclusion	Acupuncture for the treatment of abnormal scars has a low level of evidence thus requiring further well-designed, controlled trials to be performed. Recommended treatment protocols for future studies have been provided.

1.3. Special Acupuncture Techniques

1.3.1. Dry Needling

1.3.1.1. Trybulski 2024

Trybulski R, Kawczyński A, Muracki J, Lovecchio N, Kużdżał A. Dry Needling and Acupuncture for Scars-A Systematic Review. J Clin Med. 2024 Jul 9;13(14):3994. https://doi.org/10.3390/jcm13143994

Objectives	This research aims to synthesize existing data on the evidence gap in scar treatment and evaluate the effectiveness of acupuncture and dry needling in treating scars and related symptoms.
Methods	The article adhered to the PRISMA 2020 statement for recommended reporting elements in systematic reviews. The inclusion criteria followed the PICO methodology. The literature search was conducted using databases including PubMed, Cochrane Library, Semantic Scholar, Europe PubMed Central, and Google Scholar. Studies on acupuncture and dry needling for scar treatment were included. Because of the diversity of the studies' results and methodologies, a systematic review was conducted to organize and describe the findings without attempting a numerical synthesis.
Results	Nineteen studies relevant to the article's theme were identified, with eleven selected for detailed review. The studies included two case reports on dry needling, one case series on dry needling, five case reports on acupuncture, two randomized controlled trials on acupuncture, and one case report on Fu's subcutaneous needling. A quality assessment was conducted using the JBI CAT and PEDro scales. Four case reports scored 7 points, one case scored 8 points, three cases were rated 6 points or lower, the case series was rated 6 points, and the randomized controlled trials scored 8 and 5 points. Most studies demonstrated a desired therapeutic effect in scar treatment with acupuncture and dry needling, but the level of evidence varied across studies. The analysis does not conclusively support the use of acupuncture and dry needling to improve scar conditions.
Conclusions	Although dry-needling and acupuncture techniques are popular in physiotherapy, adequate scientific evidence is currently not available to support their effectiveness in scar treatment. There are gaps in the research methodology, a lack of randomized trials, and significant heterogeneity in the assessment of effects.

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