Respiratory problems

Asthma, Allergic rhinitis, Sinusitis, Colds and Flu, Eczema and Psoriasis, Acne, Herpes

Asthma

About asthma

Asthma is a chronic inflammatory disorder of the airways characterised by variable airflow obstruction and airway hyper-responsiveness, and the presence of symptoms (more than one of wheeze, breathlessness, chest tightness and cough) (British Thoracic Society 2012). Around 5.4 million people in the UK are currently treated for asthma – 4.3 million adults and 1.1 million children (Asthma UK). Up to 5% of adults with the condition have severe disease that responds poorly to treatment (Dennis 2008), while childhood asthma can be difficult to distinguish from viral wheeze (Keeley 2005).

Many people with asthma are atopic and, when they are exposed to certain stimuli, have inflammatory and structural changes in their airways (Duff 1992, Chan Yueng 1995). There are many such stimuli, for example, environmental allergens, occupational sensitising agents and respiratory viral infections (Duff 1992, Chan Yueng 1995).

The aim of treatment is to minimise or eliminate symptoms, prevent exacerbations and maximise lung function, with minimal unwanted effects (British Thoracic Society 2012). Standard therapy for patients with symptomatic asthma includes a short-acting beta2-agonist for symptom relief as needed, and prophylaxis with an inhaled corticosteroid, sometimes with the addition of a long-acting beta2-agonist (British Thoracic Society 2012). Other drugs used include leukotriene antagonists and theophylline.

References

Asthma UK. Asthma facts and FAQs [online]. Available: http://www.asthma.org.uk/asthma-facts-and-statistics

British Thoracic Society, Scottish Intercollegiate Guidelines Network, 2009. British guideline on the management of asthma. A national clinical guideline. Revised edition 2012 [online]. Available: https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-guideline-on-the-management-of-asthma/

Dennis RJ et al. Asthma in adults. Clinical Evidence. Search date June 2008.

Keeley D, McKean M. Asthma and other wheezing disorders in children. Clinical Evidence. Search date October 2005.

Duff AL, Platts-Mills TA. Allergens and asthma. Pediatr Clin North Am 1992; 39: 1277–91.

Chan-Yeung M, Malo JL. Occupational asthma. N Engl J Med 1995; 333: 107–12.

 

How acupuncture can help

This factsheet looks at the evidence for acupuncture in the treatment of asthma. There is a related factsheet on chronic obstructive pulmonary disease.

The respected Cochrane collaboration reviewed acupuncture for asthma in 2003, finding insufficient high-quality evidence to say whether or not acupuncture is effective (McCarney 2003). As well as the general concerns about the validity of sham acupuncture controls (Lundeberg 2009), McCarney also noted that some of the asthma trials used points in the sham arm that are traditionally indicated for the treatment of asthma, potentially biasing the results against acupuncture. There has been no recent systematic review that provides an authoritative evaluation and addresses these concerns.

A Chinese meta-analysis reported acupuncture to be superior to a control group for most subjective and objective measures of asthma but did not specify the nature of the control(s) (Yu 2012). A systematic review of laser acupuncture for childhood asthma located only three low-quality trials and hence was inconclusive (Zhang 2012). Several randomised controlled trials (RCTs) published since the McCarney systematic review have suggested that acupuncture is better than no treatment, and may also be a useful adjunct to standard medical care for asthma (Reinhold 2014, Sheewe 2012, Choi 2010, Lin 2010, Mehl-Madrona 2007, Zhang 2007, Maa 2003). There is also some indication of superiority over placebo (Karlson 2013, Chu 2007). In most of these studies, patients have felt better after acupuncture even if their objective lung function tests were not significantly improved. In contrast, a series of four Chinese RCTs found that moxibustion was as good as long-term asthma medication for pulmonary function as well as subjective symptoms (Chen 2013, Sang 2012, Ouyang 2011, Liang 2010). There is also evidence to support acupuncture as an effective treatment for acute asthma attacks: a large trial showed it to be similar to inhaled salbutamol (Han 2012). Acupuncture has been found to be cost effective by virtue of improving quality of life (Rheinhold 2014). (For further details of all studies see Table overleaf).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.

There are many published studies investigating the mechanisms by which acupuncture may have an effect in asthma, showing that it may help relieve asthma by:

  • having regulatory effects on mucosal and cellular immunity in patients with allergic asthma, as shown, for example, by changes in levels of immunoglobulins, eosinophils, T-lymphocytes and cytokines (Yang 2013, Carneiro 2010, Joos 2000);
  • reducing bronchial immune-mediated inflammation, particularly through the balance between T helper 1 and 2 cells and their associated cytokines (Carneiro 2010; Carneiro 2005, Jeong 2002). Reducing inflammation in general by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
  • regulating expression of surfactant proteins, that help to reduce airways resistance biophysically and also modulate the immune response (Yan 2010);
  • inhibiting structural changes in the airways, and hence reducing airways resistance, possibly by inhibiting T-type calcium channel protein in airway smooth muscle cells (Wang 2012);
  • regulating the expression of genes and proteins that control the airways inflammatory response (Mo 2012, Xu 2012, Yin 2009);
  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010).

References

Lundeberg T et al. Is placebo acupuncture what it is intended to be? Evid Based Complement Alternat Med. 2009 Jun 12.

Allergic rhinitis

Allergic rhinitis

Allergic rhinitis (perennial and seasonal) affects around 10-40% of the population worldwide, and can have a substantial health and economic impact on the community.(Sibbald 1991)

The condition can affect several organ systems, and cause many symptoms. Typical symptoms include sneezing, nasal itching, nasal blockage, and watery nasal discharge.(Lund 1994)

Other symptoms include eye symptoms (e.g. red eyes, itchy eyes, tearing), coughing, wheezing and shortness of breath, oral allergy syndrome (i.e. an itchy, swollen oropharynx on eating stoned fruits), and systemic symptoms such as tiredness, fever, a pressure sensation in the head, and itchiness.

Risk factors include a personal or family history of atopy or other allergic disorders, male sex, birth order (increased risk being seen in first born), and small family size.(Parikh 1997; Ross 1994) Allergic rhinitis may impair quality of life, interfering with work, sleep, and recreational activities.(Blaiss 1999)

The aim of conventional treatments for hay fever is to minimise or eliminate symptoms, improve quality of life, and reduce the risk of developing coexistent disease. Drug treatments include oral and topical antihistamines, oral and intranasal corticosteroids, leukotriene receptor antagonists and decongestants.

References

Blaiss MS. Quality of life in allergic rhinitis. Ann Allergy Asthma Immunol 1999; 83: 449-454.

Lund VJ, Aaronsen D, Bousquet J, et al. International consensus report on the diagnosis and management of rhinitis. Allergy 1994; 49: 1-34.

 

Parikh A, Scadding GK. Seasonal allergic rhinitis.BMJ 1997; 314: 1392.

 

Ross AM, Fleming DM. Incidence of allergic rhinitis in general practice, 1981-92. BMJ 1994; 308: 897-900.

 

Sibbald B, Rink E. Epidemiology of seasonal and perennial rhinitis; clinical presentation and medical history. Thorax 1991; 46: 895-901.

How acupuncture can help

Evidence from systematic reviews suggests that acupuncture and moxibustion may be a safe and effective treatment for allergic rhinitis with benefits over conventional medicine (Xiao 2009), that acupuncture can help to relieve symptoms of perennial rhinitis (Lee 2009) and that ear acupressure has a similar efficacy to antihistamines (Zhang 2010). However, the reviews also state that the evidence is mixed and the trials generally of poor quality and that more high-quality randomised controlled trials are needed to assess the effectiveness of acupuncture for allergic rhinitis, particularly seasonal (hay fever).(Roberts 2008; Lee 2009; Xiao 2009; Zhang 2010). Recent randomised controlled trials have found that acupuncture used as an adjunct to routine care for allergic rhinitis has clinically relevant and persistent benefits (Brinkhaus 2008) and is cost effective (Witt 2009). Such trials have also found that acupuncture is effective in the symptomatic treatment of perennial rhinitis (Xue 2007) and that active acupuncture is more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days (Ng 2004). (see Table below)

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to relieve pain and congestion in people with allergic rhinitis by:

  • regulating levels of IgE and cytokines, mediators of the allergic reaction to extrinsic allergens (Ng 2004; Rao 2006; Roberts 2008)
  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Han 2004; Zhao 2008; Cheng 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Sinusitis

Sinusitis

Each year, around 2% of the UK population consults their GP about a suspected sinus infection (Ashworth 2005). Most people with acute sinusitis recover with or without treatment within 10 days of seeing a GP (Williamson 2007), but about 92% are prescribed an antibacterial, even though it makes little difference to outcome.

(Ashworth 2005) Acute sinusitis is defined as inflammation of the nose and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms: blockage/congestion; discharge (anterior or posterior nasal drip); facial pain or pressure; and reduced or loss of smell. (Fokkens 2005) Other symptoms can include toothache (involving the upper teeth), tenderness, swelling, malaise and fever. (Ah-See 2007) Sinusitis is considered to be chronic if it lasts for more than 12 weeks, and is associated with similar symptoms.

 

Acute sinusitis can be due to viral or bacterial infections (Fokkens 2005). Predisposing factors include upper respiratory infections, allergic rhinitis, smoking, diabetes mellitus, dental infections, and mechanical abnormalities such as deviation of the nasal septum. (Ah-See 2007) Potential complications include spreading of the infection around the eye, which possibly leads to blindness, infection of the frontal bone, and meningitis. (Ah-See 2007) Symptoms and signs of such potentially serious complications include swelling of the eyes or lids, eye redness, displacement of the eye, double vision, reduced vision, severe frontal headache, and signs of meningitis. (Scadding 2008) Chronic sinusitis is uncommon, usually develops from acute sinusitis and can be due to poor drainage of the affected sinus, inflammatory changes to the lining of the sinus that result from infection, and a flare-up of infection from time to time as a result of these changes. Sometimes other factors may cause, or contribute, to the development of chronic sinusitis. For example, a persisting allergy that causes inflammation in a sinus, and swelling or blockage of the drainage channel.

 

Management of sinusitis includes paracetamol or ibuprofen for pain relief, with the addition of codeine if necessary. Steam inhalation and saline nasal solution are also sometimes used. Antibacterial therapy is appropriate only for patients who are systemically very unwell, and have symptoms and signs of, or are at high risk of, serious complications.

 

References

Ashworth MA et al. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000. Br J Gen Pract 2005; 55: 603-8.

Williamson IG et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA 2007; 298: 2487-96.

Fokkens W et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60: 583-601.

Scadding GK et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008; 38: 260-75.

Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334: 358-61.

How acupuncture can help

Evidence from randomised controlled trials suggests that acupuncture may help relieve symptoms of sinusitis such as nasal congestion (Sertel 2009), though it may not be as effective as conventional medication (Rossberg 2005; Stavem 2008). However, research is very limited and more high-quality randomised controlled trials are needed to assess the effectiveness of acupuncture for sinusitis (see Table below)

 

 

Acupuncture may help to relieve pain and congestion in people with sinusitis by

  • increasing endorphins (Ham 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states
  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Colds and flu

Acute upper respiratory tract viral infections are the most commondiseases of human beings (Eccles 2005). Adults have two to five common coldseach year and school children have from seven to ten colds per year (Johnston1996).

The common cold is most often caused byrhinoviruses (Heikkinen 2003). It is a short mild illness with early symptomsof headache, sneezing, chills and sore throat, and later symptoms of nasaldischarge, nasal obstruction, cough and malaise (Eccles 2005). Generally, theseverity of symptoms increases rapidly, peaking 2-3 days after infection, witha mean duration of symptoms of 7-10 days but with some symptoms persisting formore than 3 weeks.

Influenza is caused by infectionwith influenza A and B viruses. In the UK, outbreaks of influenza occur in mostwinters, cause much illness and are a major burden on the NHS (Meier 2000). Influenzais an unpleasant but usually self-limiting disease. The illness can affect both the upper and lowerrespiratory tract, and is often accompanied by systemic signs and symptoms,such as: abrupt onset of fever; chills; non-productive cough; myalgias;headache; nasal congestion; sore throat; and fatigue (Cox 1998). It maybe complicated by, for example, otitis media, bacterial sinusitis, secondarybacterial pneumonia, meningitis, encephalitis or exacerbations of underlyingdisease (Department of Health 2010). In the UK, 1.3% of people with influenza-like illness are hospitalisedeach year (Cooper 2003), and influenza and its complications cause around3,000-4,000 deaths in an average year (far more during a major epidemic) (Meier2000). Older people, young children and immunosuppressed people are most atrisk of developing complications.

 

The aim of management is to reducethe duration and severity of influenza symptoms, and the risk of complications;and to minimise adverse effects of treatment. Management of the common coldinvolves drugs to alleviate symptoms, such as mild analgesics. For influenza,there are also antivirals.

References

Cox NJ,Fukuda K. Influenza. Infect Dis Clin North Am 1998; 12: 27-38.

Cooper NJ,Sutton AJ, Abrams KR, et al. Effectiveness of neuraminidase inhibitors intreatment and prevention of influenza A and B: systematic review and metaanalysesof randomised controlled trials.BMJ 2003; 326: 1235-9.

Departmentof Health, 2010a. Immunisation againstinfectious disease – Chapter 19Influenza [online]. Available: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_118923.pdf [Accessed…].

Eccles R.Understanding the symptoms of the common cold and influenza. Lancet Infectious Diseases 2005; 5:718-25.

HeikkinenT, Jarvinen A. The common cold. Lancet 2003; 361: 51-9.

Johnston S,Holgate S. Epidemiology of viral respiratory infections. In: Myint S,Taylor-Robinson D, eds. Viral and other infections of the human respiratorytract. London: Chapman & Hall, 1996: 1-38.

Meier CP etal. Population-based study on incidence, risk factors, clinical complicationsand drug utilisation associated with influenza in the United Kingdom. Eur J Clin Microbiol Infect Dis 2000;19: 834-42.

How acupuncture can help

Evidence from randomised controlled trials suggeststhat electroacupuncture (Xiao 2007), acupuncture (Kawakita 2008; Kawakita 2004)and acupressure (Takeuchi 1999) may help relieve the symptoms of the commoncold (see Table below). However, there is very little research so far in thisarea, and substantially more would be required to draw firm conclusions.

 

Acupuncture may help relievesymptoms of colds and flu by:

  • enhancing natural killer cell activities andmodulating the number and ratio of immune cell types (Kawakita 2008);
  • reducing pain through the stimulationof nerves located in muscles and othertissues, which leads to release of endorphins and other neurohumoral factors(Pomeranz 1987);
  • reducinginflammation through the release of vascular and immunomodulatory factors(Kavoussi 2007, Zijlstra 2003);
  • increasinglocal microcirculation (Komori 2009), which aids dispersal of swelling.

Allergic respiratory diseases can often be associated with skin disorders.

Eczema and Psoriasis

Eczema and Psoriasis

Atopic eczema (also known as atopic dermatitis) is a very common inflammatory skin condition.(Guidelines 2006) It is characterised by an itchy red rash that typically tends to involve the skin creases (e.g. behind the knees, folds of elbows, around the neck), and is usually relatively mild.(Emerson 1998) In the acute stage, eczematous lesions are poorly defined and red with oedema, vesicles, and weeping. In the chronic stage, lesions are marked by skin thickening.

 

The condition is most commonly seen during childhood: in the UK, it affects around 15-20% of school-age children at some stage, but also affects some 2-10% of adults.(Kay 1994; Williams 2000; Poyner 2001) Most of those affected have relapses and remissions over months or years.(Williams 2000) Although childhood atopic eczema is usually mild, itching, pain and discomfort, loss of sleep, and limitation of activities can disrupt everyday life, including schooling, and can cause considerable distress for children and their families.(Barnetson 2002) The causes of eczema are not well understood and are probably due to a combination of genetic and environmental factors(Cookson 2002), such as house dust mites,(Van Bever 2002) pollution,(Polosa 2001) and prenatal or early exposure to infections.(Kalliomake 2002)

Conventional treatments include emollients (as creams, ointments or bath oils), topical corticosteroid creams, and calcineurin inhibitors (tarcrolimus and pimecrolimus). Also, patients should be advised to avoid contact with soaps and detergents, and limit exposure to possible exacerbating factors such as house dust mite, furry animals, extremes of temperature and, in hypersensitive individuals, certain foodstuffs.(McHenry 1995; Poyner 2001)

 

Psoriasis (chronic plaque psoriasis, or psoriasis vulgaris) is a chronic inflammatory skin disease. It is characterised by well-defined red, scaly plaques on the extensor surfaces of the body (e.g. knees, elbows, hands sacrum) and scalp.

The condition affects about 2% of people in the UK. In some patients, symptoms are mild, while in others they can cause physical, social and psychological disability. The course of the condition varies widely, with flare-ups and remissions. The cause of psoriasis is not known, but there is a genetic component, with around 30% of people having a family history of the disease. Also, emotional stress, physical trauma, acute infection, and some drugs can provoke or exacerbate the condition. (RCGP 1991; Naldi 2005) Excessive alcohol consumption and smoking may also be risk factors. (Poikolainen 19990; Monk 1986; Williams 1994)

Conventional treatments include topical treatments such as vitamin D and vitamin A derivatives, dithranol cream, coal tar preparations, topical corticosteroids, psoralen and ultraviolet light therapy (PUVA), and systemic treatments such as methotrexate, ciclosporin, acitretin and biologics (e.g. infliximab, etanercept).

 

References

Barnetson R, Rogers M. Childhood atopic eczema. BMJ 2002; 324: 1376-9.

Cookson W. Genetics and genomics of asthma and allergic diseases. Immunol Rev 2002; 190: 195-206.

Emerson RM et al. Severity distribution of atopic dermatitis in the community and its relationship to secondary referral. Br J Dermatol 1998; 139: 73-6.

Kalliomaki M, Isolauri E. Pandemic of atopic disease – a lack of microbial exposure in early infancy? Curr Drug Targets Infect Disord 2002; 2: 193-9.

Kay J et al. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol 1994; 30: 35-9.

McHenry PM et al. Management of atopic eczema. BMJ 1995; 310: 843-7.

Monk BE, Neill SM. Alcohol consumption and psoriasis. Dermatologica 1986; 173: 57-60. Naldi L et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case control study. J Invest Dermatol 2005; 125: 61-7.

Poikolainen K et al. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990; 300: 780-3.

Polosa R. The interaction between particulate air pollution and allergens in enhancing allergic and airway responses. Curr Allergy Asthma Rep 2001; 1: 102-7.

Poyner T. PCDS atopic eczema guidelines optimise GP management. Guidelines in Pract 2001; 4: 1-9.

Primary Care Dermatology Society &British Association of Dermatologists, 2006. Guidelines for the management of atopic eczema (online). Available: http://www.bad.org.uk/healthcare/guidelines/PCDSBAD-eczema.pdf

Van Bever HP. Early events in atopy. Eur J Pediatr 2002; 16: 1-9.

Williams HC, Wüthrich B. The natural history of atopic dermatitis. In: Williams HC (Ed). Atopic dermatitis. The epidemiology, causes and prevention of atopic eczema. Cambridge: Cambridge University Press, 2000.

Williams HC. Smoking and psoriasis. BMJ 1994; 308: 428-9. Workshop of the Research Unit of the Royal College of Physicians of London; Department of Dermatology, University of Glasgow; British Association of Dermatologists. Guidelines for management of patients with psoriasis. BMJ 1991; 303: 829-35.

How acupuncture can help

There are few published randomised controlled trials (RCTs) of the effects of acupuncture in the treatment of chronic inflammatory skin conditions such as atopic eczema and psoriasis. Two small RCTs found that acupuncture reduced itch in patients with atopic eczema (Pfab 2011; Pfab 2010). On the other hand, a small RCT of acupuncture for psoriasis concluded that classical acupuncture is not superior to sham acupuncture (Jerner 1997). Sham interventions are not inactive placebos, but effectively different versions of acupuncture, so their value in evaluating treatment efficacy is highly questionable. (see Table below)

 

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

 

Acupuncture may help to relieve symptoms in people with atopic eczema and psoriasis by:

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • regulating mediators of the allergic reaction to extrinsic allergens, for example Ig-E (Rao 2006), serum cytokines (IL-2, IL-4, IL-10, IFN-, Ig-E) (Okumura 2002), and basophils (Pfab 2011);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

Acne

Acne

Acne vulgaris, the most common type of acne, is a chronic inflammatory skin disease affecting hair follicles, and sebaceous glands and ducts. It occurs on the face in 99% of those affected and, less often, on the back and chest.(Layton 2010)

 

Characteristic features include overproduction of sebum (seborrhoea); thickening of the follicle stratum corneum, which can lead to blockage and accumulation of sebum to form non-inflamed lesions called comedones; colonisation of the pilosebaceous ducts by Propionibacterium acnes; and inflamed lesions (e.g. papules, pustules, inflamed nodules, pus-filled cysts) that may be superficial or deep.(Layton 2010; Garner 2003) Scarring can result from abnormal wound healing following inflammatory damage.(Layton 2010) Acne conglobata is an uncommon and unusually severe form of acne characterised by burrowing and interconnecting abscesses and irregular scars.

 

In the UK, around 15 per 1,000 people have acne.(Schofield 2009) The condition usually starts in adolescence and frequently resolves by the mid-20s.(Layton 2010) Severe disease can persist for 12 years or longer.(Layton 2010) Acne can have an impact on psychological well-being.(Schofield 2009; Smithard 2001) The exact cause of acne is unknown, but androgen secretion is the major trigger for adolescent acne.

 

Conventional treatments include topical products containing azelaic acid or benzoyl peroxide for mild acne, topical or oral antibiotics, topical or oral retinoids and, for women, pills containing anti-androgens (eg Dianette).

 

References

Garner SE. Acne vulgaris. In: Williams H (Ed). Evidence Based Dermatology.

London: BMJ, 2003.

Layton A. Disorders of the sebaceous glands. In: Burns DA et al (Eds). Rook’s

Textbook of Dermatology. Eighth edition. London: Blackwell Publishing, 2010.

Schofield JK et al. Skin conditions in the UK: a health care needs assessment.

First edition. Nottingham: Centre of Evidence Based Dermatology, 2009.

Smithard A et al. Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Br J Dermatol 2001;145: 274-9.

Strauss JS et al. Guidelines of for acne vulgaris management. J Am Acad Dermatol 2007; 56: 651-63.

Webster GF. Acne vulgaris: state of the science. Arch Dermatol 1999; 135: 1101-2.

 

How acupuncture can help

Evidence pooled together in a systematic review has shown that acupuncture plus moxibustion is safe and effective for the treatment of acne, and possibly better than routine western medicine.(Li 2009) (see Table below) In one randomised controlled trial, acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life, but there was no non-acupuncture control for comparison (Son 2010). In another, adding warming moxibustion to a baseline acupuncture treatment improved the outcomes similarly to that of adding the drug isotretinoin(Mi 2010). Finally, one trial found body acupuncture to have some effect in the treatment of acne vulgaris, and that the addition of laser auricular irradiation may improve efficacy (Lihong 2006). There is very little research on acupuncture and acne outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to treat acne through one or more of the following general mechanisms, but as yet we have no specific information from studies on people with acne:

 

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

Herpes

Herpes

Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus that has lain dormant in the dorsal root ganglion after primary infection (as chickenpox). It affects the sensory ganglia and their areas of innervation, and is characterised by pain in the distribution of the affected nerve, and crops of clustered vesicles over the area. Pain may occur days before rash onset, or no rash may appear (zoster sine herpete), making the diagnosis difficult.

The annual incidence of herpes zoster varies with age, being very rare in children, occurring in 2-3 cases per 1,000 people in early adult life and in up to 10 per 1000 in those aged 80 years and over.(Dworkin 2001) The severity of the symptoms also increases with age.(Jolleys 1989) Some people suffer from post herpetic neuralgia after shingles, due to nerve damage.(Opstelten 2002) Acupuncture treatment of this is covered in another Factsheet (see Chronic Pain).

 

Conventional treatment involves giving an antiviral drug such as aciclovir, as soon as possible, to limit the damage caused by the herpes zoster virus. Corticosteroids may be used to reduce inflammation, and medication may be given to help with the pain, such as topical lidocaine.

 

References

Dworkin RH, Schmader KE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. In:Watson CPN, Gershon AA, eds. Herpes zoster and postherpetic neuralgia. 2nd Rev Edn. Vol. 11. Amsterdam: Elsevier; 2001; 39-64.

Jolleys JV. Treatment of shingles and post-herpetic neuralgia. BMJ 1989; 298: 1537-8.

Opstelten W et al. Herpes zoster and postherpetic neuralgia: incidence and risk factors using a general practice research database. Fam Pract 2002;19:471-475.

How acupuncture can help

Evidence from a systematic review of studies assessing the treatment of herpes zoster with acupuncture suggests that acupuncture therapy is effective for the condition.(Yu 2007) In a randomised controlled trial, electroacupuncture in combination with surround needling was found to be effective in facilitating crust formation and pain relief in patients with herpes zoster, and the effect was superior to that of medication.(Li 2009) Another randomised controlled trial found that acupuncture (surround needling) had a positive effect on cure rate in patients with herpes zoster, and that adding moxibustion to acupuncture improved the cure rate, and reduced the time to crust formation and the incidence of residual neuralgia.(Zhang 2007) (see Table below). There is very little research on acupuncture and shingles outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light.

 

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

 

Acupuncture may help to relieve symptoms in people with herpes zoster by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Han 2004; Zhao 2008; Cheng 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

However, we have yet to see physiological data specific to herpes zoster, and/or measured on patients with this condition.

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