Dry Needling and Acupuncture for Scars—A Systematic Review

This systematic review investigated the efficacy of acupuncture and dry needling in the treatment of scars and related symptoms. The study followed PRISMA 2020 guidelines and included a comprehensive search of multiple databases through January 2024. Of 706 results initially identified, 19 studies were considered relevant, with 11 selected for detailed analysis. Methodology included quality assessment using JBI scales for case reports and PEDro for randomized clinical trials.

The studies analyzed showed great heterogeneity in terms of types of scars treated, needling techniques used, and treatment parameters. Scars studied included keloids, hypertrophic post-burn scars, surgical scars, and mature scars of different origins. Interventions varied significantly: needles of different sizes (0.15×15 mm to 0.30×50 mm), distinct insertion techniques (perpendicular, parallel, angled), treatment durations of 3-8 weeks, and frequencies of 2-3 sessions per week. Some studies combined acupuncture with other modalities such as infrared radiation, ultrasound, manual therapy, and topical medications.

Results showed positive trends in most studies. Pain assessment using VAS and NRS scales demonstrated significant reductions: from 8/10 to 3/10 in one study and from 7/10 to 4.5/10 in another. Functional improvements were observed through tests such as 'up and go' and 'chair stand test', with the SF-36 questionnaire showing an increase in physical capacity from 40% to 65%. The POSAS scale indicated significant improvement in scar appearance, decreasing from 57/70 to 27/70 points.

The Vancouver Scar Scale (VSS) also demonstrated improvements in color, vascularization, height, and pliability of scars. However, methodological quality of studies varied considerably. Case reports scored between 4-8 points on the JBI scale, while randomized clinical trials obtained 5-8 points on the PEDro scale. The main limitation identified was the lack of standardization in treatment protocols and absence of STRICTA guidelines in most studies.

The study identified several important methodological deficiencies: limited number of randomized clinical trials, small samples, lack of adequate control groups in many studies, and significant heterogeneity in assessment methods. The diversity of scar types, needling techniques, and dose parameters made meta-analysis impossible. Possible mechanisms of action proposed include: mechanical stimulation of connective tissue, modulation of the inflammatory response, release of bioactive substances, inhibition of vascular endothelial growth factor (VEGF), and stimulation of fibroblast activity. However, these mechanisms were not adequately investigated in the included studies.

Clinical implications remain uncertain due to the limited quality of the evidence. Although some studies showed promising results, the absence of standardized protocols, lack of long-term studies, and predominance of case reports limit the clinical applicability of the findings. The authors concluded that, despite the growing popularity of these techniques, there is no adequate scientific evidence to support their routine use in scar treatment.