Add-on effect of plum-blossom needling in alopecia areata: a qualitative evidence synthesis.

Background: Alopecia areata (AA) is highly unpredictable, and therapeutic efficacy remains variable, which often prompts patients to seek alternative therapies. Plum-blossom needling has been widely used for thousands of years. The purpose of this meta-analysis was to critically evaluate the add-on effect of plum-blossom needling in AA and compared it with that of conventional treatment, which would provide guidance for AA therapy.

Methods: We searched PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), and WanFang database. We included randomized controlled trials that evaluated the add-on effect of plum-blossom needling treatment compared with conventional treatment alone group for AA. The risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We also evaluated the relative risk (RR) and confidence interval (CIs) of response rate (any regrowth, major regrowth, and complete regrowth) between the plum-blossom needling add-on and the conventional control groups.

Results: Finally, eleven articles involving 1,192 patients were included in this meta-analysis (632 cases in the plum-blossom needling combination group and 560 in the conventional control group). The quality of these studies was medium or relatively low. The application of plum-blossom needling add-on therapy had consistent beneficial effects in any regrowth (RR 1.220; 95% CI: 1.108-1.343; P<0.01; Q=48.388, I2=79.334%), major regrowth (RR 1.403; 95% CI: 1.180-1.668; P<0.01; Q=68.359, I2=85.371%), and complete regrowth (RR 1.331; 95% CI: 1.104-1.606; P<0.01; Q=31.968, I2=68.718%). Subgroup analysis showed that plum-blossom needling add-on effect remained significant when topical treatment was used. Plum-blossom needling add-on therapy was generally well-tolerated, with no significantly increased risk of Adverse Events (RR 1.391; 95% CI: 0.475-4.073; P<0.01; Q=1.366, I2=0%).

Conclusions: Our meta-analysis showed that the combinations of plum-blossom needling provided moderate positive add-one effects in AA patients. Further well-designed research is required to evaluate the optimal plum-blossom needling treatment procedure.