Exploring the Use of Cupping in Dermatology

Complementary and integrative health modalities have become increasingly popular in the United States, with an estimated 30% of adults and 12% of children utilizing such approaches in 2012, according to the National Center for Complementary and Integrative Health.^1-2 One technique that has been gaining attention is an ancient practice called cupping that reportedly dates as far back as 1500 BC, with evidence of use in Egypt, China, and the Middle East. ¹

Cupping “involves creating suction on the skin using a glass, ceramic, bamboo, or plastic cup,” as explained in a 2018 review by Yssr Soliman, MD candidate, department of internal medicine, Albert Einstein College of Medicine in New York, and colleagues.. “Negative pressure is created in the cup either by applying a flame to the cup to remove oxygen before placing it on the skin or by attaching a suction device to the cup after it is placed on the skin.” The 2 basic forms of this intervention are dry cupping and wet cupping; the skin is pierced as part of wet cupping but not dry cupping.

Cupping is still used today in various parts of the world, although new adaptations have been developed over time. Several athletes participating in the 2016 Olympics in Rio de Janeiro, Brazil, bore visible marks from cupping, which has been found to increase oxygenation of the muscles and thus may improve muscular pain and recovery.^1,4

The systematic review of 8 randomized control trials examined evidence regarding the use of cupping in the treatment of dermatologic conditions, as highlighted here.¹

●       Wet cupping was found to be superior to standard care in improving cure rate, symptoms, and incidence of post-herpetic neuralgia in 651 patients with herpes zoster, with no serious adverse effects.

●       A cure rate of 55% was found in 20 patients  treated with cupping for urticaria compared with 30% in 20 control patients treated with an antihistamine and a traditional Chinese remedy.

●       Patients with acne vulgaris who were treated with wet cupping and a Chinese herbal mask for 2 weeks demonstrated greater clinical improvement than control group participants treated with the herbal mask alone (94.7% vs 61.1%, respectively).

●       Wet cupping was found to be effective in treating acute eczema (n=46) compared with oral loratadine and topical ointment (n=42), with a “cured and markedly effective rate” of 89.1% vs 42.9%, respectively.⁵ One case report described a child who, the day after undergoing cupping, developed blisters and oozing that progressed into deep ulcers. “The authors advocated against seeking ‘extreme alternative therapy’ because eczema is more safely treated with topical steroids and emollients,” wrote Soliman and colleagues.

●       In a case report of a 30-year-old man with psoriasis who had been unsuccessfully treated with steroid creams, cupping led to a 90% remission, with no new lesions noted at the 6-month follow-up.

●       In a study of 20 patients with erysipelas who underwent a combination of needling and cupping for 3 to 7 sessions, 16 patients experienced relief of symptoms with no relapse observed during the study period. While the investigators  did not recommend cupping in place of antibiotic treatment, they suggested that it may reduce inflammation and pain via improved circulation.

There have been reports of adverse events including skin irritation and bruising, infection, anemia, burns, and panniculitis with cupping. However, in several of these cases the procedure was performed by an untrained individual rather than a trained professional.¹

Although these results show promise for the use of cupping in dermatology, most “studies and reports were carried out using a small sample size and qualitatively assessed the efficacy of treatments,” concluded  Soliman and colleagues.¹ “More studies, and preferably randomized controlled trials, are needed to truly demonstrate the role of cupping in treating dermatological conditions.”

Dermatology Advisor checked in with co-author Amor Khachemoune, MD, FAAD, FACMS, of the department of dermatology at the State University of New York Downstate Medical Center in Brooklyn, for a brief discussion regarding cupping.

Dermatology Advisor: Overall, what is known thus far about the benefits of cupping in dermatology?

Amor Khachemoune, MD: There is scientific data suggesting that cupping in its traditional and modified forms is effective in several infectious and inflammatory dermatologic conditions such as herpes zoster with postherpetic neuralgia, erysipelas, acne vulgaris, eczema, and psoriasis.

Dermatology Advisor: What are the proposed mechanisms underlying these effects?

Dr Khachemoune: Our understanding of the exact mechanisms of action for cupping in all of its forms is still in its infancy. The proposed therapeutic effects of wet cupping may be linked to the excretion of oxidants from the body. There is also an increase in oxygenated hemoglobin in the area of cupping. In addition, increased heat shock protein 70 (HSP70) and beta-endorphin expression were noted in patients treated with cupping.⁶

Dermatology Advisor: What are some top takeaways for clinicians interested in cupping?

Dr Khachemoune: As there is no standardized regimen that is advocated to be effective in managing any of the dermatologic conditions I mentioned, clinicians interested in cupping should be cautious about recommending cupping for the management of other skin conditions that have established management protocols and guidelines.

Dermatology Advisor: What further research is needed in this area?

Dr Khachemoune: More standardized protocols of research should be developed to assess the efficacy of cupping for the management of skin conditions and to compare it with other treatment modalities.

Follow @DermAdvisor

References

1. Soliman Y, Hamed N, Khachemoune A. Cupping in dermatology: a critical review and update. Acta Dermatovenerol Alp Pannonica Adriat. 2018; 27(2):103-110.
2. National Center for Complementary and Integrative Health. Complementary, alternative, or integrative Health: What’s in a name? https://nccih.nih.gov/health/integrative-health Accessed April 17, 2019.
3. National Center for Complementary and Integrative Health. Cupping. https://nccih.nih.gov/health/cupping?nav=govd Accessed April 11, 2019.
4. Rozenfeld E, Kalichman L New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther.. 2016; 20(1):173-178.
5. Yao J, Li NF. Clinical observation on pricking and blood-letting and cupping with a three-edge needle for treatment of acute eczema. Zhongguo Zhen Jiu. 2007;27(6):424-426.
6. Subadi I,  Nugraha B, Laswati H, Josomuljono H. Pain relief with wet cupping therapy in rats is mediated by heat shock protein 70 and ß-endorphin. Iran J Med Sci. 2017; 42(4): 384-391.