Acupuncture for the treatment of psoriasis?

Acupuncture is a medical practice rooted in Chinese belief about the balance between the opposing forces of yin and yang, as well as the flow of vital energy known as "qi". According to the theory, qi circulates through channels called meridians, which are connected to various organs and functions of the body. When the qi is unbalanced or blocked, it is believed to cause illness.

To do this, the acupuncturist utilises fine needles which they insert at specific points on the body known as acupuncture points, along the energy meridians. Each point has specific therapeutic effects. The targeted acupuncture points are located along the nerve, blood, lymphatic pathways, or even dermal and bone points. The acupuncturist aims to restore the body's energy balance, thus contributing to the maintenance of overall health.

During a session, the needles can be left in place for 15 to 30 minutes. This method is used to treat a variety of health issues, such as chronic pain (back pain, joint pain and migraines), digestive problems, sleep disorders, anxiety, etc. Acupuncture is often used in conjunction with other medical treatments.

The psoriasis can have multiple causes, including genetic predisposition, stress or even alcohol consumption. Moreover, the manifestations of this skin condition are varied. It is essential for anyone suffering from psoriasis to consult both a general practitioner and a dermatologist.

• Prescription of medications specific by the dermatologist: For severe cases of psoriasis, the dermatologist may prescribe specific medications in addition to local management.

• Characteristics of the acupuncture session: In traditional Chinese medicine, psoriasis is defined as an impairment of the METAL movement (lung - large intestine) and of the major meridian "Taiyang" (small intestine - bladder).

• Session Procedure: The acupuncturist will begin by conducting a clinical examination of the skin and will establish a specific diagnosis for each case of psoriasis. The acupuncture session takes place in a relaxed atmosphere. The patient is lying down and is in a state of relaxation.

• Procedure: The acupuncturist will use the appropriate number of needles, aiming to alleviate both the symptoms of psoriasis and the potential triggers that have caused the psoriasis flare-up. The acupuncture session typically lasts between 15 and 30 minutes.

• Frequency of sessions: The frequency of acupuncture sessions for psoriasis will be determined in agreement with the acupuncturist, taking into account the specifics of each individual case.

In the event of an inflammatory flare-up, the priority is given to the dissipation and soothing of the heat, which can be relatively uncomfortable to endure and often prompts the individual to seek consultation. For sessions outside of flare-up periods, the aim is to identify the causes of psoriasis using the four characteristic stages of acupuncture. The goal is to understand the energy mechanisms mentioned earlier.

Once the cause has been identified and the initial session conducted, the frequency of subsequent sessions will be tailored based on the progression of the condition and the individual patient's response. As this can vary from one person to another, sessions may be spaced from one to several weeks apart, depending on the patient's needs and the severity of the psoriasis.

A study investigated the effects of acupuncture on patients suffering from psoriatic arthritis. The patients underwent a cycle of 10 sessions, accompanied by narrow-band UVB rays. The primary acupuncture points were Dazhui, Zhiyang, and Yaoyangguan. The auxiliary points were Huatuojiaji, Fengchi, Quchi, Hegu, Xuehai, and Feishu. The results showed that the PASI score had decreased from 21.45 ± 10.52 before treatment to 2.68 ± 2.70 after treatment, representing an effectiveness rate of 97.6%. Another study analysed the impact of acupuncture on 60 patients with plaque psoriasis. Psoriatic lesions were able to be reduced by 50%. According to this same study, acupuncture would be effective at all stages of psoriasis.

However, a study assessed the effectiveness of acupuncture in 56 patients suffering from plaque psoriasis, undergoing two sessions per week. After 10 weeks, the PASI score decreased from 9.6 to 8.3, whereas in the control group who received a "fake" acupuncture, a simulation, the PASI score decreased from 9.2 to 6.9. This clearly shows that acupuncture is not effective for everyone.

There are certain limitations to these studies. Indeed, the mechanism behind acupuncture therapy for psoriasis is not yet clear due to small sample sizes and the difficulty in using controls in studies. There have only been a small number of studies on acupuncture therapy for psoriasis, and especially few conducted outside of China. This may be explained by patients' fear of developing the Koebner phenomenon, the appearance of a pre-existing skin condition on a healthy skin area following a mechanical trauma.

In general, the effectiveness of acupuncture is still a topic of debate in scientific literature. Its use can be beneficial for some patients to alleviate their symptoms but it is not a standalone treatment. Therefore, it is essential to consult a qualified health professional to assess each case individually and determine the appropriate plan. Perseverance and regularity in following the sessions are important to achieve significant results.

• JERNER B. & al. A controlled trial of acupuncture in psoriasis : No convincing effect. Acta Dermato-Venereologica (1997).

• XIANG Y. & al. An overview of acupuncture for psoriasis vulgaris, 2009–2014. Journal of Dermatological Treatment (2016).

• YEH M. & al. Acupuncture-related techniques for psoriasis: A systematic review with pairwise and network meta-analyses of randomized controlled trials. Journal of Alternative and Complementary Medicine (2017).