A Systematic Review on the Efficacy of Fire Needling for the Treatment of Acne

Eui Byeol Kim; Ki Wan Kang; Min Ji Kim; Ja Yeon Kang; Min Jeong Jeong; In Soo Jang

doi:10.13045/acupunct.2016024

J Acupunct Res > Volume 33(2); 2016 > Article

Kim, Kang, Kim, Kang, Jeong, and Jang: A Systematic Review on the Efficacy of Fire Needling for the Treatment of Acne

Review Article

Acupuncture 2016; 33(2): 151-164.

DOI: https://doi.org/10.13045/acupunct.2016024

A Systematic Review on the Efficacy of Fire Needling for the Treatment of Acne

Eui Byeol Kim¹, Ki Wan Kang², Min Ji Kim¹, Ja Yeon Kang², Min Jeong Jeong³, In Soo Jang^2,^*

¹Department of Korean medicine, College of Korean medicine, Woosuk University

²Department of Internal medicine, College of Korean medicine, Woosuk University

³Department of Pediatrics, College of Korean medicine, Woosuk University

^*Corresponding author: Junghwasandong 2-5 Jeonju, Jeonbuk, Republic of Korea. 560-833,
Tel: +82-63-220-8608, E-mail: mackayj@naver.com

Received May 20, 2016 Revised May 22, 2016 Accepted May 23, 2016

See the Original "".

Abstract

Objectives:

The purpose of this study is to review clinical studies about the efficacy of fire needling for the treatment of acne vulgaris.

Methods and Results:

In this review, Oasis, NDSL, CNKI, PubMed, Cochrane, J STAGE and CINII were used as the main databases for searching for medical journals, using the keywords “acne and fire needling”, “acne and fire needle”, “acne and fire acupuncture”, and “acne and red hot needle”, The initial search range included only randomized controlled trials (RCTs), and papers not matching inclusion criteria were excluded. Initially a total of 108 studies were found, with ten being excluded during title and abstract screening. After scanning 98 papers, a total of 31 RCTs were selected and analyzed. In the 31 RCTs patients with acne were randomized into groups for treatment and control. Specifically the treatment group received fire needling, while the control group were concurrently given other treatments. The results of the completed studies have shown that the treatment group receiving fire needling demonstrated significant improvement compared to the control group.

Conclusion:

During our study it was verified that the efficacy of fire needling for the treatment of acne vulgaris was both significant and meaningful. Therefore, fire needling can be a safe and effective alternative treatment for acne. However, to confirm this result, further investigation in a traditional clinic is required accompanied by high quality studies including randomized, placebo-controlled double-blind trials.

Key Words: Acne; Acne vulgaris; Fire needle; Fire needling; Fire acupuncture.

Fig. 1

Flow chart of the trial selection process

A total of 108 studies were found, with ten being excluded during title and abstract screening. After scanning 98 papers, a total of 31 RCTs were selected and analyzed.

Table 1

RCTs of Fire needling for Acne

First author (year)	sample size	(A) Interventions group	(B) Control group	Outcome assesment	Results	jadad scale
Fan¹⁵⁾^* –2016	(A) n=25 (B) n=26	Fire needling • Once in 5 days × 4 times •Skin lesions	Tazarotene cream (external use) +Clindamycin phosphate gel (external use)	ER^†	(A): 96.0 % (B): 73.1 % (p<0.05)	2
Jiang¹²⁾^* –2014	(A) n=30 (B) n=30	Fire needling • Once in 5 days × 4 times •Skin lesions	Doxycycline (oral medication) +Adapalene gel (external use)	ER	(A): 69.0 % (B): 40.0 % (p<0.05)	3
Wang²³⁾^* –2014	(A) n=42 (B) n=38	Fire needling • Once in 2~3 days × 10 times •Skin lesions	Acupuncture •Skin lesions, LI11, LI4, SP10, SP6	ER	(A): 92.8 % (B): 78.9 % (p<0.05)	1
Huang²⁷⁾ –2004	(A) n=71 (B) n=57	Fire needling • Once a week × 4 times •Skin lesions	0.025 % Tretinoin cream	ER	(A: 95.8 % (B): 73.7 % (p<0.01)	1

^* The baseline characteristics are similar (p>0.05)

^† ER: The clinical effective rate.

Table 2

RCTs of Fire needling with Traditional Korean Medicine for Acne compared to Western Medicine

First author (year)	sample size	(A) Interventions group	(B) Control group	Outcome assesment	Results	jadad scale
Yang²⁴⁾ -2015	(A) n=23 (B) n=23	Fire needling •Twice a week × 8 times •Skin lesions +Xiaocuotangjiajian	Isotretinoin soft capsules (oral medication)	ER^†	(A): 87.0 % (B): 69.6 % (p<0.05)	1
Zhang⁴²⁾^* -2015	(A) n=85 (B) n=85	Fire needling •Unrecorded for 4 weeks •Skin lesions +Zhongtongan Capsule	Roxithromycin (oral medication) +Clindamycin phosphate gel (external use)	ER	(A): 78.8 % (B): 51.8 % (p<0.05)	1
Wang¹⁸⁾^* -2015	(A) n=31 (B) n=31	Fire needling •Unrecorded for 2 months •Skin lesions +Acupuncture (LI20, SI18, CV24, Ex-HN3, LI4, LI11, SP10, ST44, SP9, ST36) +Moving cup manipulation +Qingrechushitang	Minocycline hydrochloride (oral medication)(br)+Clindamycin phosphate (external use)	ER	(A): 90.32 % (B): 58.06 % (p<0.01)	2
Wang¹⁴⁾^* -2014	(A) n=75 (B) n=75	Fire needling •Twice a week×4 times •Skin lesions BL13,BL17, BL20, BL21, BL25 +Mahuangfuzixixintangjiajian	Minocycline hydrochloride (oral medication)	1) ER 2) IL-2^‡	1) (A): 85.33 % (B): 53.33 % (p<0.05) 2) (A): 7.21 ± 4.22 (B): 10.19 ± 3.41 (p<0.05)	2
Chen³⁶⁾^* -2014	(A) n=35 (B) n=35	Fire needling •Twice a week × 8 times •Skin lesions +Acupuncture +Plum-blossom needle and cupping therapy (GV14, BL13, BL15, BL17, BL21, BL23)	Isotretinoin (oral medication)	ER	(A): 85.71 (B): 65.71 (p<0.05)	1
	Mild group (A) n=35 (B) Control1: n=35 Control2: n=35		Control 1) Acupuncture •LI4, LI11, ST44, GB14, ST2		Mild group (A): 97.1 % (B) Control1: 88.6 %, Control2: 82.9 % (p<0.05)
Zheng²⁶⁾ -2010	Moderate group (A) n=40 (B) Control1: n=40 Control2: n=40	Fire needling •Once in 3~7 days for 8 times •Skin lesions +Blood-pricking therapy and cupping (BL13, BL15, BL18, BL20, BL23, BL25)	Control 2) Metacycline (oral medication) +Hydrochloride clindamycin phosphate gel (external use)	ER	Moderate group (A): 95.0 % (B) Control1: 87.5 % Control2: 77.5 % (p<0.05)	1
	Severe group (A) n=35 (B) Control1: n=35 Control2: n=35				Severe group (A): 91.6 % (B) Control1: 85.7 %, Control2: 77.1 % (p<0.05)

^* The baseline characteristics are similar (p>0.05)

^† ER: The clinical effective rate.

^‡ IL-2: Serum interleukin-2 Levels

Table 3

RCTs of Fire needling with Traditional Korean Medicine for Acne compared to Traditional Korean Medicine without Fire needling

First author (year)	sample size	(A) Interventions group	(B) Control group	Outcome assesment	Results	jadad scale
Yang33)^* -2015	(A) n=34 (B) n=33	Fire needling • Once or twice a week × 4 times •Skin lesions +Pingcuofangjiajian	Xiaocuowan	ER^†	(A): 79.41 % (B): 42.42 % (p<0.05)	1
Li^16)* -2015	(A) n=32 (B) n=30	Fire needling •Twice a week × 20 times •Skin lesions +Cupping therapy •Skin lesions	Acupuncture •GV14 Bl13 BL21 BL17 (selection of points according to syndrome)	1) ER 2) Acne-QoL^‡	1) (A): 71.88 % (B): 66.67 % (p<0.05) 2) •Self-perception: (A): 25.59 ± 5.30 (B): 22.69 ± 4.63 (p<0.01) • Role-emotional: (A): 26.24 ± 4.13 (B): 21.69 ± 7.13 (p<0.01) • Role-social: (A): 18.44 ± 2.13 (B): 17.32 ± 3.21 (p<0.05)	2
Yang²¹⁾ -2015	(A) n=45 (B) n=44	Fire needling • Once a week × 6 times •Skin lesions +Pipaqingfeiyinjiajian	Pipaqingfeiyinjiajian	ER	(A): 93.3 % (B): 70.5 % (p<0.05)	0
Jiang^28)* -2014	(A) n=84 (B) n=84	Fire needling •Once a week × 3 times •Skin lesions, BL13, BL15, BL18, BL20, BL23, CV6, CV4 +Herbal medicine after differentiation of syndrome	Herbal medicine after differentiation of syndrome	ER	(A): 97.6 % (B): 90.5 % (p<0.05)	1
Deng^20)* -2014	(A) n=30 (B) Control1: n=30 Control2: n=30	Fire needling •Once a week × 8 times •Skin lesions +Moxibustion on Aconiti Lateralis Preparata Radix cake (ST36, CV4, CV6)	Control 1) Fire needling •Same as (A) Control 2) Moxibustion •Same as (A)	ER	(A: 90.00 % (B) Control 1: 73.33 %, Control 2: 70.00 % (p<0.05: (A) and Control 1) (p<0.05: (A) and Control 2)	1
Yang^34)* -2014	(A) n=60 (B) n=60	Fire needling • Twice a week × 4 times •Skin lesions +Xiaocuosanjietang	Xiaocuosanjietang	ER	(A: 80.0 % (B): 55.0 % (p<0.05)	1
Li^10)* -2011	(A) n=23 (B) n=22	Fire needling •Once a week × 8 times •Skin lesions, BL13, BL15, BL18, BL20, BL23, CV12, ST25, CV6, CV4 +Yahnhuotangjiajian	Yahnhuotangjiajian	ER	(A): 95.65 % (B): 72.73 % (p<0.05)	2
Zheng²⁶⁾ -2010	Mild group (A) n=35 (B) Control1: n=35 Control2: n=35	Fire needling •Once in 3~7 days for 8 weeks •Skin lesions +Blood-pricking therapy and cupping (BL13, BL15, BL18, BL20, BL23, BL25)	Control 1) Acupuncture •LI4, LI11, ST44, GB14, ST2	ER	Mild group (A): 97.1 % (B) Control1: 88.6 %, Control2: 82.9 % (p<0.05)	1
	Moderate group (A) n=40 (B) Control1: n=40 Control2: n=40		Control 1) Acupuncture •LI4, LI11, ST44, GB14, ST2		Moderate group (A): 95.0 % (B) Control1: 87.5 %, Control2: 77.5 % (p<0.05)
	Severe group (A) n=35 (B) Control1: n=35 Control2: n=35		Control 2) Metacycline (oral medication) +Hydrochloride clindamycin phosphate gel (external use)		Severe group (A): 91.6 % (B) Control1: 85.7 %, Control2: 77.1 % (p<0.05)

^* The baseline characteristics are similar (p<0.05).

^† ER: The clinical effective rate.

^‡ Acne-QoL,: The Acne-Specific Quality of Life Questionnaire.

Table 4

RCTs of Fire needling with Traditional Korean Medicine for Acne compared to Integrated Medicine Therapy

First author (year)	sample size	(A) Interventions group	(B) Control group	Outcome assesment	Results	jadad scale
Hu^35)* -2015	(A) n=30 (B) n=30	Fire needling • Every other week × 8 times •Skin lesions +Xiaocuotang	Adapalene gel (external use) +Xiaocuotang	ER^†	(A): 23.3 % (B): 10.0 % (p<0.05)	1
Tao^37)* -2014	(A) n=33 (B) n=30	Fire needling • Once in 5 days × 6 times •Skin lesions +Moving cup manipulation +blood-pricking therapy and cupping	Yiqing capsule (oral medication) +Fusidic acid cream (external use)	ER	(A): 100.00 % (B): 83.33 % (p<0.05)	1
Huang^32)* -2012	(A) n=44 (B) n=44	Fire needling • Once a week × 4 times +Sanpixiaocuotangjiajian	Clindamycin phosphate gel (external use) +Sanpixiaocuotangjiajian	ER	(A): 86.83 ± 5.61 (B): 53.48 ± 7.82 (p<0.05)	1

^* The baseline characteristics are similar (p<0.05).

^† ER: The clinical effective rate.

Table 5

RCTs of Fire needling with Integrated Medicine Therapy for Acne

First author (year)	sample size	(A) Interventions group	(B) Control group	Outcome assesment	Results	jadad scale
Jiang^13)* -2015	(A) n=28 (B) n=29	Fire needling • Once a week × 4 times •Skin lesions +Isotretinoin soft capsules (oral medication)	Isotretinoin soft capsules (oral medication)	ER^†	(A): 89.3 % (B): 34.5 % (p<0.01)	3
					•Self-perception: (A): 3.76 ± 1.88 (B): 2.37 ± 2.24 (p<0.01)
Li^30)* -2015	(A) n=32 (B) n=29	Fire needling • Once a week × 4 times •Skin lesions +Blue and red light therapy +Gypsum chinese medicine mask sheet	Qingrexiaocuotang	Change of Acne-QoL before and after interventions	• Role-emotional: (A): 6.27 ± 2.42 (B): 2.19 ± 1.94 (p<0.01)	1
					• Role-social: (A): 5.36 ± 2.12 (B): 3.03 ± 2.58 (p<0.01)
Li^38)* -2015	(A) n=58 (B) n=50	Fire needling •Twice a week × 4 times •Skin lesions +Huajianxiaocuoyinjiajian +Blue and red light therapy	Huajianxiaocuoyinjiajian	ER	(A): 96.6 % (B): 72.0 % (p<0.05)	1
Wu^29)* -2015	(A) n=48 (B) n=47	Fire needling • Once a week •Skin lesions +Chinese medicine mask sheet Blue and red light therapy	Chinese medicine mask sheet +Blue and red light therapy	1) ER 2) GAGS^‡	1) (A): 95.83 % (B): 74.47 % (p<0.05) 2) (A): 4.56 ± 1.71 (B): 29.78 ± 7.72 (p<0.05)	1
Liu^11)* -2015	(A) n=30 (B) n=30	Fire needling • Once a week × 8 times •Skin lesions +Blue and red lights therapy	Blue and red light therapy	1) ER 2) GAGS	1) (A): 83.3 % (B): 50 % (p<0.05) 2) (A): 2.33 ± 2.11 (B): 9.27 ± 2.03 (p<0.05)	2
Chen^17)* -2015	(A) n=57 (B) n=63	Fire needling • Once a week × 4 times •Skin lesions +Blue and red light therapy +Mori Cortex Radicis mask sheet +Hospital original herbal medicine Qingfu 2 (oral)	Blue and red light therapy +Hospital original herbal medicine Qingfu 2 (oral)	ER	(A: 86.0 % (B): 46.0 % (p<0.05)	2
Cui^22)* -2014	(A) n=20 (B) n=20	Fire needling •Twice a week × 5 times •Skin lesions +Qingrejieduyin +Clindamycin phosphate gel (external use)	Tanshinone capsule +Clindamycin phosphate gel (external use)	ER	(A): 90 % (B): 50 % (p<0.01)	1
Fu^40)* -2014	(A) n=30 (B) n=30	Fire needling • Once a week × 8 times •Skin lesions +20 % fruit acid	20 % fruit acid	ER	(A): 83.3 % (B): 63.3 % (p<0.05)	1
Tian^41)* -2014	(A) n=220 (B) n=212	Fire needling •Twice a week × 8 times •Skin lesions +Helium-Neon lasers	Helium-Neon lasers	ER	(A): 82.7 % (B): 77.4 % (p<0.05)	0
Shen²⁵⁾ -2013	(A) n=100 (B) n=100	Fire needling •Twice a week × 8 times •Skin lesions +Amikacin sulfate solution (external use) +Pingcuotang	Pingcuotang	ER	(A): 97.0 % (B): 80.0 % (p<0.01)	1
Guo^39)* -2011	(A) n=65 (B) n=60	Fire needling • Twice a week × 2 times •Skin lesions +Clarithromycin (oral medication) +Clindamycin and Chlorphenamine Maleate topical solution (external use)	Clarithromycin (oral medication) +Clindamycin and Chlorphenamine Maleate topical solution (external use)	ER	(A): 95.38 % (B): 78.33 % (p<0.01)	1

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