Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin disease in the world, affecting 15–20% of children and 1–3% of adults with substantial impact on quality of life — especially due to the intense, disruptive pruritus that fragments sleep and compromises daily activities. Despite advances with biologics (dupilumab) and JAK inhibitors, many patients do not have access to these treatments or show partial response, creating demand for evidence-based complementary options. Published in December 2024 in BMJ Open, a systematic review and meta-analysis conducted by Shuang Liang and colleagues gathered the highest-quality available trials on acupuncture for AD.
The researchers systematically searched six databases — PubMed, Embase, CENTRAL, CNKI, WanFang, and VIP — through October 2024, identifying 8 randomized clinical trials with 463 participants. The primary outcomes included SCORAD (SCORing Atopic Dermatitis — a 0 to 103 scale that assesses extent, intensity, and subjective symptoms such as pruritus and sleep loss), EASI (Eczema Área and Severity Index), the pruritus VAS, and the DLQI (Dermatology Life Quality Index). The analysis identified significant reductions in three of the four outcomes — with SCORAD and pruritus reaching the threshold of minimum clinically important difference (MCID).
RESULTS BY OUTCOME
Outcome analysis: what the numbers mean clinically
The reduction of −10.61 points in SCORAD is clinically relevant: the MCID for this instrument in adults with AD is estimated at around 8–9 points, and the observed difference exceeds that threshold. This means that, on average, patients treated with acupuncture experience a perceptible and significant improvement in the extent and intensity of eczema. The reduction in pruritus (−14.71 on the 0–100 mm VAS) is particularly impactful — pruritus is frequently the most disabling symptom of AD, responsible for insomnia, excoriations, and secondary infections.
The EASI did not reach statistical significance (MD = −3.95; p = 0.08), possibly due to the lower sensitivity of this instrument for detecting moderate changes in small samples. The DLQI — which assesses impact on daily activities, work, leisure, relationships, and sleep — improved significantly (MD = −2.37), confirming that improvement in SCORAD and pruritus translates into perceived benefit in daily life. No serious adverse event was documented in the included studies.
Safety: absence of serious adverse events
One of the most relevant findings for clinical practice is the safety profile: no serious adverse event was recorded in the 8 included RCTs. The minor adverse events described in the studies — such as mild local hematoma and transient discomfort at the needle site — resolved spontaneously. This profile complements topical corticosteroids (risk of skin atrophy), calcineurin inhibitors (burning sensation), and systemic immunosuppressants (risk of infection), although acupuncture also has adverse events (local hematoma, vasovagal syncope, rare cases of pneumothorax), making acupuncture particularly attractive as a complement to conventional treatment or as an option for patients who wish to reduce medication burden.
Frequently Asked Questions
Acupuncture does not replace conventional treatment for AD, but in this meta-analysis it shows clinically significant benefits in pruritus and SCORAD that may complement or reduce the need for topical corticosteroids in patients with mild to moderate disease. The decision to adjust conventional therapy should always be made with the dermatologist. Acupuncture is especially valuable as a complement in patients with unsatisfactory response or concerns about long-term corticosteroid use.
Medical acupuncture can be adapted for children with atopic dermatitis. For younger children (under 5 years) or those with needle phobia, alternatives such as low-power laser at the same acupoints (laser-puncture), auriculotherapy with seeds (non-invasive), or acupressure are equally valid options. The studies in this meta-analysis included primarily adults, but the pathophysiology of AD and the mechanisms of action of acupuncture are comparable in children. The medical acupuncturist evaluates suitability for each age group.
The studies in this meta-analysis varied in protocol, but generally used 8–12 weeks of treatment with 2–3 weekly sessions. In my clinical practice, some patients report perceptible improvement in pruritus after a few sessions. The frequency and duration of protocols should be individualized by the medical acupuncturist; clinical trials included in the meta-analysis typically used cycles of 4 to 12 weeks with weekly or twice-weekly frequency.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).