Evaluation of Cupping Therapy in Some Dermatoses

Background: Cupping is an ancient traditional therapeutic technique, used mainly for the treatment of chronic pain and also for an array of respiratory, neurological, gastroenterological and gynaecological disorders, particularly in oriental countries. However, its mechanism of efficacy is still obscure. The present study was designed to evaluate the clinical effect of cupping therapy on some dermatoses and to figure out its probable mechanism of action. Methods: Fifty patients [12 chronic idiopathic urticaria (CIU),9 atopic dermatitis,11 acne vulgaris,10 vitiligo and 8 psoriasis vulgaris] were treated by "wet cupping technique". IgE, C3 and IL-2 levels were measured in serum samples collected from the patients before and after ending the cupping therapy. Results: Clinical improvement has been noticed in 24 out of the 50 patients (12 CIU, 10 acne vulgaris and 2 atopic dermatitis patients), while all vitiligo and psoriasis patients did not show any improvement. After cupping therapy, serum IgE and IL-2 levels significantly decreased (p=0.006, p=0.001 respectively), while serum C3 level significantly increased (p=0.02) in those 24 patients. Conclusions: Chinese wet cupping can be considered an effective alternative or complementary therapy for CIU and acne vulgaris patients. The change in serum IgE, IL-2 and C3 levels after cupping therapy, in improved patients, may suggest that cupping therapy performs its action through correcting abnormalities in the immune system. Egyptian Dermatology Online Journal Vol. 9 No 1: 2, June 2013 2 http://www.edoj.org.eg Introduction Cupping is an ancient traditional therapeutic technique that has been practiced, for thousands of years and till now, particularly in East Asian countries [1]. In Egypt and Arabic countries, cupping therapy is known as "Al-Hijama. Recently, the number of followers of this traditional medicine is increasing in the western world [2]. This therapy involves the application of a suction cup to a localized area of the skin; this area is termed acupoint [1]. Seven major types of cupping are practiced in China. The basic suction method of cupping therapy is called retained cupping, which is most commonly used in Chinese clinics as the first type of cupping. In this method practitioners utilize the flaming heating power to achieve suction (minus pressure) inside the cups to make them apply on the desired part of the body. The second type of cupping is bleeding cupping (wet cupping), in which practitioners make some small incisions before applying the suction cups. Besides, there are different types of cupping applied with different methods. Each kind of cupping therapy may be used for different diseases or different purposes of treatment [3]. Although its exact mechanism of efficacy remains obscure, cupping is mainly prescribed as a treatment for chronic pain. It is also indicated for an array of respiratory, neurological, gastroenterological and gynecological disorders [1]. In the field of dermatology, cupping has been used, with varying degree of success, for the treatment of skin diseases as cutaneous infections [4], urticaria [5], acne vulgaris [6] and chloasma [7]. Nowadays, as the use of alternative therapies is on the rise, the use of cupping may undoubtedly become more common [8]. The present study aims to evaluate the clinical efficacy of cupping therapy in some dermatoses and to figure out its probable mechanism of action. Patients and Methods This study included 50 patients and was approved by the Ethics Committee for Postgraduate Studies and Research of Al-Minya University. The patients were 31 males and 19 females and their ages ranged from 11-67 years old (mean±SD 27.1±12.2). After having an informed consent, for using cupping therapy, from these patients or their guardians, they were divided into 5 groups: Group I: 12 patients with chronic idiopathic urticaria (CIU) (8 males, 4 females, age range 11-50 years with a mean and SD of 27.7±11.4). Group II: 9 patients with atopic dermatitis (6 males, 3 females, age range 11-34 years with a mean and SD of 22.4±8.8). Group III: 11 patients with acne vulgaris; 7 nodulocystic type and 4 Egyptian Dermatology Online Journal Vol. 9 No 1: 2, June 2013 3 http://www.edoj.org.eg papulopustular type (5 males, 6 females, age range 17-27 years with a mean and SD of 21±3.9). Group IV: 10 patients with vitiligo (4 males, 6 females, age range 1340 years with a mean and SD of 27.6±10.5). Group V: 8 patients with psoriasis vulgaris (8 males, age range 17-67 years with a mean and SD of 39±18.5). Patients with CIU were diagnosed by the occurrence of daily, or almost daily, wheals and itching for at least 6 weeks with no apparent cause [9]. In patients with atopic dermatitis and psoriasis vulgaris, diagnosis was proved by a lesional skin biopsy. Patients were instructed to stop any treatment at least 4 weeks before starting cupping therapy as well as throughout the therapy sessions. Patients with bleeding tendency, severe anemia, diabetes, renal or hepatic failure, hepatitis B or C positive patients and pregnant women were excluded. Also, patients aged below 10 or above 70 years old were excluded.