Acupuncture for chloasma: A systematic review and meta-analysis of randomized controlled trials

Introduction: Chloasma is a common acquired facial skin disorder characterised by irregular brownish macules and patches. Acupuncture has been widely used for chloasma management in Asia. The objective of this review was to evaluate the efficacy and safety of acupuncture for chloasma. Methods: Seven databases were searched for randomized controlled trials of acupuncture for chloasma against conventional treatment, sham acupuncture, and no treatment, published before the first of May 2017. The Cochrane risk of bias tool was used to assess the risk of bias. Effectiveness rate was the primary outcome. Secondary outcomes included lesion size score, lesion color score, and adverse events. Two reviewers extracted data independently. The data was pooled using RevMan V5.2. Risk ratio (RR) was used for dichotomous outcomes and mean difference (MD) was adopted for continuous outcomes. The confidence interval (CI) was established at 95%. Results: Twelve studies involving 912 participants were included, which were generally of low methodological quality. Meta-analysis showed favorable effects of acupuncture on the effectiveness rate (RR = 1.31, 95% CI = 1.09 to 1.57), lesion size score (MD = -0.97, 95% CI = -1.55 to-0.39), and lesion color score (MD = -1.09, 95% CI = -1.67 to-0.50). Acupuncture appeared to be associated with few adverse events. Conclusions: In summary, this systematic review and meta-analysis suggests that acupuncture might be effective and safe for chloasma. However, there is not enough evidence to draw any definite conclusion due to the low quality of included trials. Future clinical trials with strong methodology should be conducted.