Acne

Acne vulgaris is a long-term inflammatory disease of the pilosebaceous unit, the hair follicle and the oil gland attached to it, which shows as blackheads and whiteheads and as inflamed papules, pustules, nodules and cysts on the face, chest and back, as a 2024 Cochrane overview by Yuan and colleagues describes it. Cochrane has no review of acupuncture alone for acne. Its 2015 review of complementary therapies for acne vulgaris, by Huijuan Cao and colleagues at Beijing University of Chinese Medicine, found a lack of evidence to support acupuncture or wet cupping for the condition, and the 2024 overview, which included that review, found no high-certainty evidence for any topical, light-based or complementary treatment it covered. Later reviews of acupuncture, cupping, autohemotherapy and fire needling report results as good as or better than drugs, from trials that mostly compared the methods with drugs or added them to other treatments, rather than testing them against a sham.

The 2015 Cochrane review

The review searched to January 2014 and included 35 randomised trials with 3,227 participants, testing herbal medicine, acupuncture, wet cupping, diet, purified bee venom and tea tree oil against no treatment, placebo or other treatments. Wet cupping, as the review defines it, pricks the skin at chosen points with a three-edged or plum-blossom needle to draw blood and then applies a suction cup over it; Cupping and Bloodletting describe the methods. Among its trials:

• Three tested acupuncture. Against a waiting list, in a four-arm trial of men, acupuncture made no difference to lesion counts. Against azithromycin with clindamycin gel, one trial reported more people in remission with acupuncture at 3 weeks; against isotretinoin, another found no difference.
• Four tested wet cupping, three of them against drugs such as tetracycline or a retinoid cream; two of those three reported more people in remission with cupping.
• Six tested wet cupping combined with acupuncture against an antibiotic or a vitamin A acid drug. Every one of the six used GV14 (Dazhui) and BL13 (Feishu) as the main points for cupping. Lesion scores did not differ from antibiotics at 4 weeks.

Clinical differences between trials and incomplete reporting left the authors able to pool only four trials, two of diet and two of a herbal granule, so every acupuncture and cupping result rests on single trials. They judged most trials at unclear risk of bias. Reported harms of acupuncture were itch, redness and pain after needle insertion; five trials reported that wet cupping could leave black and blue marks on the skin. The review notes that its trials studied these methods in a traditional Chinese medicine context, which may limit how far the results apply elsewhere.

The 2024 overview by Yuan and colleagues, also from Beijing University of Chinese Medicine, searched to December 2021 and admitted only reviews at low risk of bias: six reviews, five of them Cochrane, covering 275 trials and 40,910 people with acne. It found no high-certainty evidence for any therapy it included, and judged the trials and reviews in the field of low methodological quality. It rated the evidence for acupuncture against a waiting list, from the one trial of 22 people, as of very low certainty, and found low-certainty evidence from one trial of 70 people that wet cupping with acupuncture improved quality of life more than drugs at 4 weeks.

Later systematic reviews

Mansu and colleagues, at RMIT University in Melbourne and Guangdong Provincial Hospital of Chinese Medicine, found that none of their trials reported all the items of the CONSORT or STRICTA reporting standards, and that the trials run in China gave no details of the practitioners or the setting. None of the reviews in the table reports GRADE certainty in its abstract. Fire needling pierces the lesion with a heated needle; Fire needling describes it.

A 2025 scoping review by Huang and colleagues at the Second Hospital of Hunan University of Chinese Medicine mapped the studies published from 2014 to October 2024: 114 studies, of which 48 were randomised trials, 63 non-randomised studies and 3 systematic reviews, almost all from China. The methods used most were needling, pricking with cupping, fire needling, autohemotherapy, bloodletting and catgut embedding, and the point chosen most often was the ashi point, the lesion itself; Ashi points explains the term. The commonest outcome was the effective rate, the share of people reaching a grade of response. Fire needling had a higher frequency of adverse events than the other methods, and output fell after 2019.

Trials with a sham or an active control

A 2022 trial at Guang'anmen Hospital in Beijing, by Jiao and colleagues, compared acupuncture with sham acupuncture; its protocol states that no earlier acupuncture trial for acne had used a sham arm. The protocol planned 100 people with moderate or severe acne, 12 sessions over 4 weeks and follow-up to week 28, with a skin-specific quality-of-life score, Skindex-16, as the main outcome. The trial found no difference between groups in that score, in lesion counts, itch or pain at 4, 16 or 28 weeks, apart from the emotions part of Skindex-16 at week 4. The authors suggest that 4 weeks may be too short and that sham acupuncture may not be inert. Sham acupuncture covers what sham procedures do.

A 2021 trial in Kerman, Iran, gave everyone azithromycin for 12 weeks and added two sessions of either wet cupping or sham cupping; 103 people with moderate to severe facial acne completed it. A dermatologist who did not know the groups graded acne as better, and lesions cleared faster, with wet cupping, and quality of life rose more.

Two small trials compared one form of needling with another. A 2010 trial at Kyung Hee University in Seoul randomised 36 people to acupuncture at standard points, with or without ah shi points, needles placed at painful or diseased sites, for 12 sessions over 6 weeks: inflammatory lesions fell in both groups, with no difference between them. A 2013 trial of 38 people gave pricking and cupping at GV14 twice a week for 6 weeks, half of them with needling at LI04 (Hegu) and LI11 (Quchi) to dull the pain. That needling reduced the pain of pricking, and acne grading scores fell in both groups with no difference between them. Neither trial had an untreated or sham group, so neither can say how much of the fall came from needling.

Has acupuncture been studied for hormonal acne?

No review has examined it separately. A 2018 trial in Lianyungang, China, randomised 107 women with acne after adolescence to catgut embedding at points, fire needling at the lesions and ear acupuncture, or to tanshinone capsules with adapalene gel, for 8 weeks. Lesion scores did not differ at 4 weeks and were lower in the acupuncture group at 8 weeks. Before treatment the women had lower oestradiol, and a higher ratio of testosterone to oestradiol, than healthy women, and in the 21 with a hormone disorder oestradiol rose and the ratio fell after treatment; there was no sham group. Polycystic ovary syndrome reports the acupuncture trials in that condition.

What guidelines say

NICE guideline NG198, Acne vulgaris: management, was published on 25 June 2021 and last updated on 3 August 2026; NICE reviewed it on 28 September 2026 and decided not to update its section on managing acne, so it is current. It recommends a 12-week course of one of its first-line treatment options, advises that there is not enough evidence to support specific diets, and does not mention acupuncture. The American Academy of Dermatology's 2024 guideline, by Reynolds and colleagues in the Journal of the American Academy of Dermatology, sets out 18 recommendations and 5 good practice statements graded with GRADE; those its abstract names cover benzoyl peroxide, topical retinoids and antibiotics, clascoterone, salicylic acid, azelaic acid, oral antibiotics, isotretinoin, hormonal treatments and steroid injections, and none concerns acupuncture. The EuroGuiDerm guideline update by Nast and colleagues, published in March 2026 to update the 2016 European S3 guideline, prioritised isotretinoin, antibiotic duration, hormonal treatment and new topical drugs; its short version describes spironolactone, used off-label, as particularly beneficial for women whose acne is linked to hormonal imbalance, such as polycystic ovary syndrome, and does not mention acupuncture. Clinical guidelines compares positions across conditions.

What the reviews could not settle

Most trials compared the methods with drugs or added them to other treatments, and the 2025 scoping review rated the randomised trials of moderate methodological quality overall, with few of high quality. The sham-controlled trial of body acupuncture found no difference from sham, and its authors name a course of 12 weeks or longer, with a waiting-list or drug comparison, as the next test; the sham-controlled trial of wet cupping gave cupping on top of an antibiotic, so it does not show what cupping does alone. No review has weighed hormonal acne apart from acne in general. The scoping review's authors call for large multicentre trials that report to standard and measure objective outcomes. Where the trials come from discusses what the country of a study tells a reader.

AcuiQ's acne and acne vulgaris pages list the protocols clinical texts and individual studies prescribed, each with its citation.