A New Therapy for Vitiligo Using Fire Needles: A Systematic Review of Evidence from 3618 Subjects

INTRODUCTION: Fire needle therapy has been reported as an effective treatment for vitiligo. However, current clinical evidence has not been systematically evaluated. The aim of this study was to determine whether fire needle therapy is effective and safe for treating vitiligo. METHODS: Seven databases were searched until October 2019 for randomized controlled trials on fire needle therapy, with and without conventional treatments, versus any type of conventional therapy for treating vitiligo. The RevMan 5.3.5 software was used to perform meta-analysis of the included studies. RESULTS: Forty-seven trials comprising 3618 patients were included. Fire needle combined with conventional vitiligo treatments had a higher efficacy (risk ratio (RR): 1.55, 95% confidence interval (CI): 1.46–1.65, P < 0.00001 and RR: 1.41, 95% CI: 1.24–1.61, P < 0.00001, respectively) and a greater effect on restoring the color of the area of the skin lesion (mean difference (MD): 3.40, 95% CI: 2.11–4.69, P < 0.00001), increasing the pigment point of vitiligo (MD: 0.83, 95% CI: 0.54–1.13, P < 0.00001) and improving the cytokine level (MD: 8.10, 95% CI: 6.94–9.27, P < 0.00001) and effectual time (MD: −4.76, 95% CI: −7.33 to −2.19, P=0.0003) than traditional methods. Limb lesions (RR: 1.60, 95% CI: 1.31–1.95, P < 0.00001) were more effectively treated when the treatments included fire needles, whereas the therapeutic effect of fire needles on either the head and neck (RR: 1.13, 95% CI: 0.78–1.64, P=0.52) or torso lesions (RR: 1.22, 95% CI: 0.82–1.81, P=0.33) was not significantly different compared to that without fire needles. No statistically significant differences in adverse effects (RR: 1.15, 95% CI: 0.89–1.49, P=0.28) and recurrence rates (RR: 0.90, 95% CI: 0.17–4.92, P=0.91) during the follow-up period were observed between treatment with and without fire needles. CONCLUSIONS: Fire needle therapy combined with other conventional treatments is useful in treating vitiligo. Further studies with larger sample sizes should be performed to make a conclusive judgment. This trial is registered with CRD42018094918.