Research Spotlight: Cupping and Acne

Cupping for Acne: An Ancient Technique Makes a Comeback

What is cupping?

Cupping is a traditional Chinese medical technique used to treat a variety of ailments. The two main types of cupping therapy include wet and dry cupping. Dry cupping involves placing a glass against the skin, commonly the back or chest, and heating or cooling the gases inside the cup to cause a vacuuming and suctioning effect. The suctioning of skin into the cup causes local trauma to superficial dermal blood vessels, creating ecchymoses in a circular arrangement.¹ In wet cupping, superficial lacerations of the skin pull blood into the cup during the procedure.²

Reported effects of cupping

Although the mechanism of action of cupping has remained a medical mystery, there are several theories about what happens at the microscopic level. Some research suggests cupping improves circulation and removes toxins or waste from the body. Cupping is also seen to raise pain thresholds,³ reduce inflammation, and modulate the immune system.²

Via the “release of nitric oxide and increased blood circulation theory,”⁴ cupping has been found to be a beneficial complementary therapy in the treatment of carpal tunnel syndrome and chronic back pain.⁵ Niasari et al. conducted a study to determine the effect of wet cupping on serum lipoprotein levels. They found that in the patients who underwent wet cupping, serum LDL cholesterol and LDL/HDL concentrations were reduced.⁶ In a study done on 20 thalassemic children, one session of wet cupping in conjunction with iron chelating therapy resulted in a reduction of iron overload, serum ferritin, and oxidative stress, while also increasing antioxidant capacity.⁷ Cupping has also been shown to significantly reduce the severity of migraine pain.⁸ In a study measuring systolic and diastolic blood pressure in hypertensive patients, wet cupping resulted in a reduction in systolic blood pressure for up to four weeks.⁹

Cupping and Acne

Acne is one of the most common conditions treated by dermatologists in the US.¹⁰ There are many mechanistic targets for treatment when dealing with acne vulgaris. The four most prevalent disease mechanisms of acne are the release of inflammatory mediators in the skin, alteration of keratinization process leading to comedones, altered sebum production under androgen control, and follicular colonization by P. acnes.¹¹ Although the mechanism by which cupping improves acne requires further research, cupping has emerged as a complementary treatment option for acne vulgaris.

One study sought to elucidate the benefit of adding wet cupping to acupuncture and a Chinese-drug facemask in the treatment of acne. 32 patients were selected. Their acne symptoms ranged from mild to severe. Patients underwent acupuncture, followed by wet cupping for ten minutes and a Chinese-drug face mask for thirty minutes. This was completed once every three days for 1-3 courses, and a course consisted of 10 sessions. After the 10 sessions, researchers found that 24 of the acne cases were cured, 7 cases improved, and 1 case failed. This resulted in a curative rate of 75.0% after the cupping procedure.¹²

Another study investigated the effect of acupuncture and wet cupping with or without acupuncture anesthesia. Thirty-eight acne patients were split into the control or intervention group, with both groups receiving acupuncture and wet cupping twice weekly for 6 weeks. The control group did not receive local anesthesia. The therapeutic and analgesic effects of the treatment were recorded respectively on a global acne grading system (GAGS) and visual analogue scale (VAS). The GAGS takes into account the area, distribution, and density of affected pilosebaceous units on the face, chest, and upper back. Researchers found there was reduction in the GAGS scores from baseline, but there was no significant difference between the control and intervention group. This shows all patients benefited from the acupuncture and wet cupping treatment.¹³

A series of 47 acne patients who had failed other western and Chinese treatment modalities underwent acupuncture and wet cupping. Each patient had acupuncture points alternating on their back and then 15 minutes of suction cuppings for 8 days. Out of the 47 participants, 16 were considered “cured” with resolution of skin lesions with residual hyperpigmentation. 20 participants saw a therapeutic effect of “markedly effective” demonstrating 60% clearance of skin lesions without new lesions appearing during treatment. 9 participants were “improved” with 50% clearance of skin lesions without new ones appearing during treatment. Only 2 patients were deemed “ineffectively” treated, defined as less than 40% clearance of skin lesions with new ones occurring during treatment.¹⁴

In a similar study, 50 patients underwent acupuncture and then 15 minutes of wet cupping every 3-5 days for 10 sessions. Out of the 50 patients, 27 patients were cured, 21 greatly improved, and 2 patients showed no improvement.¹⁵ Both the above studies show the beneficial effect of treating acne vulgaris with wet cupping technique.

In a 12-week randomized, single blind, intervention-sham-controlled clinical trial, 103 patients were identified as having moderate to severe acne vulgaris based on modified global acne grading score (mGAG) calculations. All participants received azithromycin 500 mg once daily three days a week for the full 12 weeks. In addition to the antibiotics, patients in the intervention group received wet cupping at the first visit and six weeks later at the second. Patients in the control group received antibiotics and sham cupping at the first and second visits. At the end of the 6^th and 12th weeks the patients mGAG scores were retaken. At the end of the 6^th (p=0.002) and 12^th (p=0.001) week grade of acne was significantly different between the groups. The intervention group had significantly improved mGAG scores over the control group. There was a decrease in acne grade in both groups but a statistically significant decrease in the intervention group. Another secondary outcome of the study was that measurements of quality of life (QQL-M) were the same in both groups at the outset but significantly increased in the intervention group compared to the control by the end of the study. This study showed wet cupping plus antibiotic therapy to be more effective in acne resolution than with antibiotic therapy alone.¹⁶

Key Takeaways

Though relatively new in mainstream skincare, the Chinese treatment of cupping for acne has been around for centuries. Based on reports in the literature, cupping for acne may be a viable, holistic alternative to Western pharmaceutical treatments. Though cupping still needs to be studied on a wider range of people, this ancient approach to skin care may be the treatment that offers new outlooks on acne.