A New Therapy for Vitiligo Using Fire Needles: A Systematic Review of Evidence from 3618 Subjects

Abstract

Introduction. Fire needle therapy has been reported as an effective treatment for vitiligo. However, current clinical evidence has not been systematically evaluated. The aim of this study was to determine whether fire needle therapy is effective and safe for treating vitiligo. Methods. Seven databases were searched until October 2019 for randomized controlled trials on fire needle therapy, with and without conventional treatments, versus any type of conventional therapy for treating vitiligo. The RevMan 5.3.5 software was used to perform meta-analysis of the included studies. Results. Forty-seven trials comprising 3618 patients were included. Fire needle combined with conventional vitiligo treatments had a higher efficacy (risk ratio (RR): 1.55, 95% confidence interval (CI): 1.46–1.65, P<0.00001 and RR: 1.41, 95% CI: 1.24–1.61, P<0.00001, respectively) and a greater effect on restoring the color of the area of the skin lesion (mean difference (MD): 3.40, 95% CI: 2.11–4.69, P<0.00001), increasing the pigment point of vitiligo (MD: 0.83, 95% CI: 0.54–1.13, P<0.00001) and improving the cytokine level (MD: 8.10, 95% CI: 6.94–9.27, P<0.00001) and effectual time (MD: −4.76, 95% CI: −7.33 to −2.19, P=0.0003) than traditional methods. Limb lesions (RR: 1.60, 95% CI: 1.31–1.95, P<0.00001) were more effectively treated when the treatments included fire needles, whereas the therapeutic effect of fire needles on either the head and neck (RR: 1.13, 95% CI: 0.78–1.64, P=0.52) or torso lesions (RR: 1.22, 95% CI: 0.82–1.81, P=0.33) was not significantly different compared to that without fire needles. No statistically significant differences in adverse effects (RR: 1.15, 95% CI: 0.89–1.49, P=0.28) and recurrence rates (RR: 0.90, 95% CI: 0.17–4.92, P=0.91) during the follow-up period were observed between treatment with and without fire needles. Conclusions. Fire needle therapy combined with other conventional treatments is useful in treating vitiligo. Further studies with larger sample sizes should be performed to make a conclusive judgment. This trial is registered with CRD42018094918.

Systematic Evaluation and Meta-Analysis of Randomized Controlled Trials of Fire Needle Combined Phototherapy for the Treatment of Vitiligo

“…Metafor (R package) was utilized for meta-analysis of identical trials and control methods. The calculation of the mean difference and the confidence interval up to 100% was used to evaluate the data measurement and the total effective rate, which was regarded as the relative risk with a confidence interval in the 95% range [ 20 ]. The statistical analysis of the same statistics was represented by the corresponding I value.…”

“…Several recent clinical trials have demonstrated that fire needle therapy is an effective psoriasis treatment; however, there are few comprehensive reviews of the therapy's efficacy [ 19 ]. Combined with other methods, the fire needles used to treat vitiligo are more efficacious [ 20 ]; vitiligo is a skin-lightening disease caused by hereditary melanocyte depletion and decreased melanin biosynthesis [ 21 ]. A fine needle is also utilized during acupuncture treatment.…”

Topical halometasone cream combined with fire needle pre-treatment for treatment of primary cutaneous amyloidosis: Two case reports

“…Fire needle has the advantages of both conventional acupuncture and moxibustion, due to needle and thermal stimulation. It can promote microcirculation, accelerate metabolism, and restore damaged tissues in the lesional area through the regulation of cutaneous nerves, which in turn can eliminate or attenuate pathological features such as edema, hyperemia, exudation, adhesion, calcification, contractures, and ischemia[ 5 ]. Fire needle also can stimulate vascular dilatation and local edema of the lesion, which promotes transdermal absorption and maximizes the efficacy of the topical agents[ 6 ].…”

“…The acupuncture needle pierces the lesion quickly after being burned red on an alcohol lamp. It has been reported that fire needle can be used for treatment of itchy, painful, inflammatory, and pigmented diseases[ 1 - 5 ], and has achieved a good therapeutic effect as an adjuvant therapy. Here, we report two cases of PCA that received fire needle pre-treatment and topical halometasone cream (Bright Future Pharmaceuticals Factory, Hong Kong), who achieved significant improvement.…”

Efficacy and Safety of Fire Needle Therapy for Flat Warts: Evidence from 29 Randomized Controlled Trials

“…It could stimulate and dredge the meridians and accelerate the flow of Qi and blood thus dissipating nodules. On this basis, the fire needles therapy has been proven to treat nodular prurigo [ 17 ], moderate severe acne [ 18 ], vitiligo [ 19 ]and psoriasis [ 20 , 21 ]. Recently, fire needle therapy has also been used to treat flat warts, and its possible therapeutic mechanism may be destroying the wart body, improving local circulation, and promoting the local immune response.…”