Vitiligo

Vitiligo : 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. Generic Acupuncture

1.2. Special Acupuncture Techniques

1.2.1. Fire needling

1.2.1.1. Guo 2024

Guo C, Gu X, Zhang J, Li J, Xu F, Wang Y, Zhang M, Zhang Y. Efficacy of fire needle combined with 308 nm excimer laser therapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials. J Cosmet Dermatol. 2024 Aug;23(8):2592-2602. https://doi.org/10.1111/jocd.16308

Introduction	Vitiligo is a common depigmenting skin disorder. This work is performed to systematically evaluate the efficacy and safety of fire needles combined with 308 nm excimer laser therapy in treating vitiligo.
Methods	We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases. Randomized controlled trials (RCTs) on fire needles combined with 308 nm excimer laser therapy with 308 nm excimer laser therapy alone for vitiligo were included. The Cochrane Collaborative Network Tool was used to assess the risk of bias. Statistical analysis was completed using RevMan5.3 software and Stata 15.0 software. The GRADE system was used to evaluate the quality of evidence for outcomes.
Results	In this study, 10 RCTs and 1333 patients were included. The results showed that compared with 308 nm excimer laser therapy alone, fire needle combined with 308 nm excimer laser therapy is more effective in improving clinical effective rate (RR = 1.36, 95% CI [1.24, 1.50], p < 0.00001), serum CD4+ level (MD = 3.12, 95% CI [2.50, 3.74], p < 0.00001), CD4+/CD8+ ratio (MD = 0.24, 95% CI [0.09, 0.39], p = 0.001), and quality of life measured by the Dermatology Life Quality Index (DLQI) (MD = 3.76, 95% CI [3.33, 4.19], p < 0.00001), and reducing the Vitiligo Area Score Index (VASI) (MD = -5.47, 95% CI [-6.56, -4.37], p < 0.00001). The reported adverse events, including redness, swelling, pain, blisters, and itching, were controllable, and all these events were well tolerated.
Conclusion	The current evidence indicates that fire needle combined with 308 nm excimer laser therapy is effective and safe for vitiligo. However, owing to the suboptimal quality of the included studies, more high-quality and large-scale RCTs are needed for comprehensive analysis and further validation.

1.2.1.2. Lin 2021 ☆

Lin Li , Yan Xiaoning, Li Wenbin, Zhao Yiding. [Meta - Analysis of Efficacy and Safety of Filiform Fire Needling in the Treatment of Vitiligo]. Journal of Clinical Acupuncture and Moxibustion. 2021;37(5):57. [220394].

Objective	To systematically evaluate the clinical efficacy of filiform fire needling in the treatment of vitiligo.
Methods	Relevant literature of randomized controlled trials focusing on the treatment of vitiligo with filiform fire needling were retrieved from the databases from CNKI, WanFang, vIP, CBM, PubMed, Cochrane Library and EMbase from the establishment of the database to December 2019. Data were extracted and literature quality was evaluated based on the Cochrane bias risk assessment method. Meta analysis was performed by using Rev ManS. 3 and StatalS statistical software.
Results	A total of 10 pieces of Chinese literature were included, involving 1, 56 patients. Meta - analysis was performed by using a fix - effect model, and the results showed that the tota1 effective rate of the experimental group was better than that of the control group, the difference was statistically significant (RR = 1. 29, 95% CI [ 1. 21, 1. 38], Z = 7. 58, P<0. 000 01), which was further verified by different interventions and different treatment courses by sub - group analysis. The safety of the two groups was ana1yzed by using a random - effect model, and the results showed it was not exactly accurate that the safety of filiform fire needling was higher than that of routine western medication (RR=0.94, 95% CI[0.44,1.98],Z=0. 17,P=0.87).
Conclusion	The treatment of vitiligo with filiform fire needling has obvious advantages over conventional treatment, and the results are stable. However, filiform fire needling has few advantages in the safety than the conventional treatment. The conclusions need to be further verified due to the small number of samples and the uneven quality of the included literature.

2. Overviews of systematic reviews

2.1. Zhao 2024

Zhao J, Gong X, Hou R, Guo D. Acupuncture for vitiligo: An overview of systematic reviews and meta-analysis. J Cosmet Dermatol. 2024 Apr;23(4):1187-1204. https://doi.org/10.1111/jocd.16107

Backgound	Vitiligo is a kind of refractory, autoimmune locally, or systemically generalized depigmentation spots caused by the disappearance of melanocyte function in the skin. Acupuncture and related therapies are extensively utilized for treating vitiligo in China. The objective of this study is to succinctly encapsulate and meticulously assess the methodological and reporting caliber of systematic reviews (SRs) pertaining to acupuncture and associated therapeutic approaches, while concurrently offering an all-encompassing body of evidence elucidating their efficacy and safety in the treatment of vitiligo.
Methods	We performed an electronic literature search in eight databases to identify SRs that evaluated the efficacy of acupuncture therapy for vitiligo. The Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological and reporting quality of these SRs. The preferred reporting items for SRs and meta-analyses were followed according to PRISMA (2020) guidelines. Additionally, the risk of bias in systematic reviews (ROBIS) was assessed to evaluate potential bias. The quality of evidence for outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
Results	This study included 10 SRs and assessed a total of 13 outcome measures, all of which were published before June 2023. Acupuncture therapy was more effective than control conditions for the treatment of Vitiligo. The AMSTAR-2 results indicated a critical deficiency in the methodological quality of all SRs, with items 7 and 16 demonstrating notably low quality. The reporting quality of the included SRs according to PRISMA was deemed unsatisfactory, with significant reporting flaws identified in the areas of Protocol and registration, Risk of bias across studies, Study selection, and Limitations. According to the ROBIS assessment, 5 out of the total number of SRs (50.00%) were found to have a high risk of bias. Out of the total of 62 outcomes evaluated using the GRADE framework, 9 outcomes (14.51%) exhibited high-quality evidence, 20 outcomes (32.26%) demonstrated moderate-quality evidence, 19 outcomes (30.65%) presented low-quality evidence, while 14 outcomes (22.58%) indicated very low-quality evidence.
Conclusions	This overview shows that Acupuncture therapy was more effective than the control treatment for Vitiligo. Nevertheless, given the subpar methodological quality of the reviews, we recommend conducting studies with stricter designs, larger sample sizes, and improved methodological and reporting quality to yield more robust evidence.

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