Effectiveness and safety of acupuncture for melasma: A meta-analysis of randomized controlled trials

Background: Treating melasma remains challenging. We conducted a meta-analysis to assess the effectiveness and safety of acupuncture as a treatment option. Methods: We searched three English and four Chinese databases up to January 2, 2024. The primary outcome was the total effective rate, while secondary outcomes included skin lesion area and color scores, total lesion score, and adverse effects. Study quality was assessed using the risk of bias tool, and data were analyzed with Review Manager 5.4. The GRADE approach evaluated evidence certainty. Results: This study included 22 studies with 1644 participants. Findings indicate that acupuncture significantly outperforms Western medicine and other treatments (risk ratio [RR] = 1.21, 95 % confidence interval [CI] (1.18, 1.30), P < 0.00001, I2 = 34 %). Acupuncture effectively reduces the area of skin lesions (mean difference [MD] =-0.35, 95 % CI (-0.52,-0.19), P < 0.0001, I2 = 93 %), lightens color (MD =-0.45, 95 % CI (-0.58,-0.31), P < 0.00001, I2 = 89 %), and lowers the total score of skin lesions (MD =-1.00, 95 % CI (-1.29,-0.70), P < 0.00001, I2 = 79 %). Adverse reactions were infrequent with acupuncture. The most common needling sites were in the facial lesion area, noted in 17 studies. Sanyinjiao (SP6) was the most frequently used acupoint (n = 8), followed by Hegu (LI4) (n = 7) and Xuehai (SP10) (n = 7). Other commonly used acupoints included Tianshu (ST25), Zusanli (ST36), Taichong (LR3), and Zhongwan (RN12). All secondary outcomes, except for the primary outcome, were rated as very low quality. Conclusion: This review confirms that acupuncture therapy effectively reduces the area and color of melasma lesions and lowers lesion scores. Acupuncture therapy appears to be a safe and effective treatment option for melasma; however, results should be interpreted cautiously due to potential publication and regional biases. Registration: CRD42024503394.