[Randomized controlled trial evidence and physicians' clinical concerns in acupuncture treatment for eczema: a...

To compare the differences between randomized controlled trial (RCT) evidence and physicians' clinical concerns in acupuncture treatment for eczema, and to provide a basis for optimizing clinical practice and future research.

RCTs on acupuncture for eczema were systematically searched in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science databases from inception to December 31, 2023. Evidence from RCTs on acupuncture treatment for eczema was collected and methodological quality was evaluated. A questionnaire on clinical concerns regarding acupuncture treatment for eczema was designed, covering population characteristics (population age, disease type, TCM syndrome), acupuncture intervention measures (types of acupuncture therapies and components of acupuncture protocols), types of control measures of concern, outcome, and selection of evaluation time points. The questionnaire was distributed nationwide among clinicians to investigate their concerns regarding acupuncture treatment for eczema. Differences and similarities between RCT evidence and physicians' clinical concerns were compared across five dimensions: study population, intervention measures, control setting, outcome, and evaluation time points.

A total of 243 RCTs and 87 valid questionnaires were included. The RCTs presented certain risks of bias. The evidence was mainly concentrated on chronic eczema of spleen deficiency with dampness excess in adolescents and adults, with insufficient attention to infants, pregnant and postpartum women, and acute/subacute eczema. The intervention measures were mainly filiform needle acupuncture, fire needle, and moxibustion; however, descriptions of acupuncture parameters and treatment courses were insufficient, and there was a lack of studies on intradermal needles and auricular acupoint pressing. Control interventions were mostly glucocorticoids for external use or antihistamines, which were not entirely consistent with clinicians' concerns regarding calcineurin inhibitors, biologics, and other modern therapeutic strategies. Outcomes mainly focused on effective rate and severity scores such as skin lesions and pruritus, whereas clinicians were more concerned with multidimensional outcomes such as quality of life, psychological status, patient satisfaction, recurrence rate, and medication use. Most studies focused only on short-term efficacy at the end of treatment, lacking data on immediate efficacy and long-term follow-up, which did not align with clinical concerns about sustained efficacy and recurrence risk.

There are certain differences between current RCT evidence and physicians' clinical concerns regarding acupuncture treatment for eczema. Future research should be guided by clinical questions, optimize population stratification design, refine descriptions of acupuncture intervention parameters, introduce more clinically relevant control groups, construct multidimensional outcome systems, and implement full-course efficacy evaluation to improve the quality of evidence and clinical applicability of acupuncture treatment for eczema.