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Complementary and Alternative Approaches II
Key points
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A review of a variety of alternative therapies for atopic dermatitis (AD) is the focus of this chapter. Among those reviewed are acupuncture, cupping, and herbal therapies, which are common traditional Chinese therapies used by AD patients.
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We discuss the limited, but compelling research surrounding acupuncture and its subtypes’ success in treating AD symptoms such as itch.
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Cupping has less clear evidence for its use. We review the positive as well as the negative effects it may produce.
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We consider ancient Chinese herbal remedies, as well as teas and caffeine, their efficacy, and how their use translates into modern treatment of AD.
Introduction
According to some experts in traditional Chinese medicine, atopic dermatitis (AD) is caused by “a congenitally weak constitution, resulting in a predisposition toward atopic diseases and susceptibility toward external or internal pathogenic factors, such as wind, dampness, and heat. Its recurrent and chronic nature can injure Yin (as in Yin/Yang) and blood and generate dryness” ( ). Traditional Chinese medicine is an alternative medicine practice that includes using many herbs that are specifically formulated for the needs of each individual patient ( ). Since this ancient definition of AD, science has come a long way in understanding the mechanism behind AD. As research moves to unveil the mechanisms responsible for the pathogenesis of AD, there will be more opportunity to understand the reasons for different treatment modalities’ efficacy or lack thereof. Until a comprehensive pathophysiology is uncovered about AD, patients may continue to seek other nonconventional practices that have succeeded in managing symptoms of many diseases for centuries. Thus patients may look to those ancient Chinese remedies such as herbal extracts for healing their diseased skin.
The current data suggest that approximately one-third of AD patients will use complementary or alternative therapies in the lifetime of their disease. This is at least in part due to the chronicity of AD, its predilection for development in pediatric populations, and treatment resistance ( ).
In the instances where patients look for alternative therapies for management of their AD, the goal should be to confirm safety of the treatment rather than move to stop its practice. The high level of patients seeking to use complementary and alternative treatment therapies may suggest that conventional health treatments are not providing high levels of satisfactory results ( ).
This chapter focuses on existing evidence and gaps in research for complementary therapies in AD, including acupuncture, cupping, and herbal therapies. We explore the human and animal trials that are starting to uncover evidence for therapies that in some cultures have been used for centuries for the treatment of dermatologic disease. Additional complementary and alternative therapies, including supplementary oils, bathing additives, topical endocannabinoids, and fabric selection, are discussed in Chapter 26 .
Physical treatments
Acupuncture
In acupuncture, thin caliber (20-40 gauge) needles are placed at specific target locations on the body to modulate neurosensory transmission. A randomized, sham-controlled, single-blinded preliminary trial with 30 adult participants with mild to moderate AD administered verum acupuncture three times weekly for 4 weeks, twice weekly for 4 weeks, and sham acupuncture twice weekly for 4 weeks. Both acupuncture groups had a significant reduction in eczema severity when compared to sham. However, there were no significant improvements in insomnia, pruritus, or EASI scoring of eczema severity ( ). A randomized, double-blinded, placebo-controlled, crossover trial with 20 adult patients with AD found higher reductions in itch intensity between acupuncture and antihistamine itch therapy and significantly higher reductions of itch when compared to placebo ( ). A 2016 review stated that acupuncture treatment for symptoms of itch seems promising, but larger, randomized, placebo-controlled studies needed to be done before conclusions can be made ( ).
Electroacupuncture
An alternative form of acupuncture is electroacupuncture in which an electrical current is passed between acupuncture needles. There are no studies on electroacupuncture treatment in human patients with AD. A study on a model of AD in rats suggests high-frequency electroacupuncture alleviates pruritus through causing dynorphin neurotransmitter release, which acts on opioid receptors to decrease itch. Paradoxically, there was no significant difference in pain scores in rats even though pain and itch share many of the same neurologic pathways ( ). Lack of human clinical trials precludes the possibility of concluding electroacupuncture can be used to treat AD until further studies are completed.
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