Objective

2

To compare the differences between randomized controlled trial (RCT) evidence and physiciansʹ clinical concerns in acupuncture treatment for eczema

and to provide a basis for optimizing clinical practice and future research.

Methods

2

RCTs on acupuncture for eczema were systematically searched in CNKI

Wanfang

VIP

SinoMed

PubMed

EMbase

Cochrane Library

and Web of Science databases from inception to December 31

2023. Evidence from RCTs on acupuncture treatment for eczema was collected and methodological quality was evaluated. A questionnaire on clinical concerns regarding acupuncture treatment for eczema was designed

covering population characteristics (population age

disease type

TCM syndrome)

acupuncture intervention measures (types of acupuncture therapies and components of acupuncture protocols)

types of control measures of concern

outcome

and selection of evaluation time points. The questionnaire was distributed nationwide among clinicians to investigate their concerns regarding acupuncture treatment for eczema. Differences and similarities between RCT evidence and physiciansʹ clinical concerns were compared across five dimensions: study population

intervention measures

control setting

outcome

and evaluation time points.

Results

2

A total of 243 RCTs and 87 valid questionnaires were included. The RCTs presented certain risks of bias. The evidence was mainly concentrated on chronic eczema of spleen deficiency with dampness excess in adolescents and adults

with insufficient attention to infants

pregnant and postpartum women

and acute/subacute eczema. The intervention measures were mainly filiform needle acupuncture

fire needle

and moxibustion; however

descriptions of acupuncture parameters and treatment courses were insufficient

and there was a lack of studies on intradermal needles and auricular acupoint pressing. Control interventions were mostly glucocorticoids for external use or antihistamines

which were not entirely consistent with cliniciansʹ concerns regarding calcineurin inhibitors

biologics

and other modern therapeutic strategies. Outcomes mainly focused on effective rate and severity scores such as skin lesions and pruritus

whereas clinicians were more concerned with multidimensional outcomes such as quality of life

psychological status

patient satisfaction

recurrence rate

and medication use. Most studies focused only on short-term efficacy at the end of treatment

lacking data on immediate efficacy and long-term follow-up

which did not align with clinical concerns about sustained efficacy and recurrence risk.

Conclusion

2

There are certain differences between current RCT evidence and physiciansʹ clinical concerns regarding acupuncture treatment for eczema. Future research should be guided by clinical questions

optimize population stratification design

refine descriptions of acupuncture intervention parameters

introduce more clinically relevant control groups

construct multidimensional outcome systems

and implement full-course efficacy evaluation to improve the quality of evidence and clinical applicability of acupuncture treatment for eczema.