Lichen and Neurodermatitis

Lichen et neuro-dermatose

1. Systematic Reviews and Meta-Analysis

1.1. Generic Acupuncture

1.1.1. Yang 2022 ☆

Yang L, Li X, Huang W, Li J, Rao X, Lai Y. The Efficacy and Safety of Acupuncture in the Treatment of Neurodermatitis: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022 Sep 1;2022:8182958. https://doi.org/10.1155/2022/8182958

Background	Neurodermatitis is a common chronic inflammatory skin disease associated with neurological dysfunction. This study aimed to explore the efficacy and safety of acupuncture and moxibustion in the treatment of neurodermatitis through meta-analysis.
Methods	We comprehensively searched 9 databases, including PubMed, Cochrane Library, EMBASE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and China Biomedicine (CBM), from their inception to November 15, 2021, for published neurological and clinical randomized controlled trials (RCTs) using acupuncture to treat dermatitis. We also searched gray literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey, and GreyNet International. Two authors independently screened the data, extracted the literature, and evaluated the quality of the literature using Cochrane 5.3.3 and Review Manager 5.4.1 software.
Results	The meta-analysis included 8 studies with a total of 728 participant, including 369 patients in the treatment group and 359 patients in the control group. Compared with conventional treatment, acupuncture significantly increased the effective rate (OR: 2.90, 95% CI: 1.78∼4.75; p < 0.001) and decreased the recurrence rate after treatment (OR: 0.26, 95% CI: 0.12∼0.59; p=0.001). Meanwhile, analysis of disease symptom scores showed that acupuncture group had a greater impact (OR: 3.51, 95% CI: 2.12∼4.91; p < 0.00001). Furthermore, no significant difference in the adverse reaction rate was observed.
Conclusion	Acupuncture is safe and effective in treating neurodermatitis. However, the current level of research evidence is limited, and therefore, larger sample and high-quality RCTs are needed to confirm its safety and effectiveness.

1.1.2. Yang 2010

Yang Fang, Wang Yi-Liang, Guo Qiang. [Systematic Assessment of Acupuncture for Treatment of Neurodermatitis in Domestic Clinical Studies]. Journal of Clinical Acupuncture and Moxibustion. 2010;26(8):1.[174286]

Objectives	To assess the effectiveness of acupuncture for treatment of neurodermatitis.
Methods	According to the requirement of evidence - based medicine, acupuncture, body acupuncture, electroacupuncture, headacupuncture, three edged needle, plum - blossom needle, fire needle , elongated needle, encircling fleedling, auricular needle, cupping, injectio ad acumen, needle - embedding, moxibustion, neurodermatitis, random, comparison, blindness method, clinical trial ,etc. were selected as retrieval words to retrieve the relative medical database at home, and clinically randomized controlled trials were used as enrolled criteria , the treatment group were treated with acupuncture or acupuncture plus other therapies, and the control group with western medicine, the cured rate and effective rate for neurodermatitis were used as assessment indexes. Altogether 10 papers were enrolled. Among them 9 papers were conducted for Meta - analysis by RevMan.
Results	The total OR was 7. 12 with 95% CI〔2.88,17. 58 〕of the clinically effective rate in the 9 studies,and the total OR was 4.07 with 95%CI[2. 21,7. 50] of the clinically cured rate in the 8 studies. The therapeutic effect in the treatment group on neruodermatitis was superior to that of the western medicine ( P <0. 01).
Conclusions	Acupuncture therapy for neurodermatitis is effective; but more high -quality studies are required to prove this view point.

1.2. Special Acupuncture Techniques

1.2.1. Cupping

1.2.1.1. Zhai 2024

Zhai Y, Hui YY, Jiang ZF, Ding L, Cheng J, Xing T, Zhai H, Zhang H. Efficacy and safety of wet cupping in the treatment of neurodermatitis: a systematic review and meta-analysis. Front Med (Lausanne). 2024 Dec 19;11:1478073. https://doi.org/10.3389/fmed.2024.1478073

Backgound	Neurodermatitis is a chronic skin condition characterized by intense itching and skin thickening due to neurological dysfunction. Its persistent nature poses a challenge to effective treatment, significantly impacting patients' quality of life. Wet cupping therapy is increasingly being used in clinics to manage neurodermatitis, so it is imperative to assess the evidence regarding its effectiveness and safety.
Objective	This review aimed to evaluate the efficacy and safety of wet cupping therapy in patients with neurodermatitis.
Methods and analysis	Randomized controlled trials (RCTs) investigating wet cupping for neurodermatitis were identified through searches of eight electronic databases and three clinical trial registration platforms from inception to March 2024, using predefined search terms. Included studies underwent quality appraisal using the Cochrane Collaboration's Risk of Bias Assessment tool. The quality of evidence was assessed independently by two reviewers using the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Meta-analysis and publication bias assessment were conducted using ReviewManager 5.4 and STATA 17.0 software, respectively.
Results	This review encompassed 19 studies, comprising 6 types of comparisons and involving 1,505 participants. The findings revealed no significant difference in the total effective rate between wet cupping alone and high-potency steroids (n = 269, RR = 1.13, 95% CI [0.90, 1.41], p = 0.29, I2 = 83%). However, wet cupping combined with medication or moxibustion exhibited superior efficacy compared to medication alone (n = 272, RR = 1.28, 95% CI [1.16, 1.41], p < 0.00001, I2 = 43%) and (n = 534, RR = 1.22, 95% CI [1.14, 1.30], p < 0.00001, I2 = 0%). Wet cupping groups demonstrated lower recurrence rates (n = 266, RR = 0.31, 95% CI [0.16, 0.60], p = 0.0005, I2 = 0%) and a reduced incidence of adverse events (n = 673, RR = 0.44, 95% CI [0.21, 0.90], p = 0.02, I2 = 36%). Furthermore, wet cupping alone or combined with moxibustion effectively lowered the levels of inflammatory factors compared to medication: TNF-α (n = 120, MD = -6.99, 95% CI [-8.13, -5.85], p < 0.00001, I2 = 0%), IL-1β (n = 120, MD = -5.28, 95% CI [-6.91, -3.65], p < 0.00001, I2 = 48%), and IL-6 (n = 180, MD = -8.61, 95% CI [-13.24, -3.99], p = 0.0003, I2 = 81%).
Conclusion	The efficacy of wet cupping therapy is comparable to that of high-potency steroids. Its combined use with medication or moxibustion appears to enhance effectiveness, reduce recurrence rates, and improve safety. However, due to the overall low grade of evidence for the identified outcomes and poor methodological quality, caution is advised when interpreting and applying these findings in clinical practice.

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