ObjectivesAtopic dermatitis is a chronic, relapsing, inflammatory skin disease that impacts patients’ quality of life and imposes substantial economic burdens on their families. Acupuncture holds promise as a viable treatment option for atopic dermatitis. This review aimed to evaluate the effect of acupuncture on atopic dermatitis.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, CENTRAL, the China National Knowledge Infrastructure, WanFang and VIP databases were searched through 17 September 2023, together with an updated search on 15 October 2024.Eligibility criteria for selecting studiesWe included randomised controlled trials (RCTs) about acupuncture for atopic dermatitis. The primary outcome was the SCORing Atopic Dermatitis (SCORAD) score. The secondary outcomes were the eczema area and severity index (EASI) score, the visual analogue scale (VAS) score for pruritus, the dermatology life quality index (DLQI) score, serum IgE level and adverse events (AEs).Data extraction and synthesisTwo independent reviewers conducted separate searches of the databases, assessed eligible articles for inclusion and employed the Cochrane Collaboration’s tool for assessing the risk of bias. The analyses were performed using RevMan 5.3 and Stata 13.0 software. The mean difference (MD) with 95% CI was employed to analyse continuous outcomes.ResultsEight studies with 463 participants were included. The meta-analysis indicated significant differences in the SCORAD score (MD=−10.61, 95% CI −17.77 to −3.45, p=0.004), the VAS score for pruritus (MD=−14.71, 95% CI −18.20 to −11.22, p<0.00001) and the DLQI score (MD=−2.37, 95% CI −3.57 to −1.18, p<0.0001), but no significant differences in the EASI score (MD=−3.95, 95% CI −8.35 to 0.45, p=0.08) and the IgE level (MD=−160.22 U/mL, 95% CI −334.13 to 13.68, p=0.07) between treatment and control. The differences in the SCORAD score and the VAS score for pruritus reached minimal clinically important differences. No serious AEs were reported.ConclusionsAcupuncture might be an effective and safe treatment for atopic dermatitis. Due to the limited quantity and quality of the included studies, it is recommended to conduct multicentre, large-scale and high-quality RCTs to further confirm the findings.PROSPERO registration numberCRD42023470643.