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Background: Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial. Methods: An allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches or control observation: acupuncture at points Quchi and Xuehai (verum acupuncture [VA], dominant side), ‘placebo-point’ acupuncture (PA, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min, wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered. Results: Mean itch intensity was significantly lower in VA (35.7 ± 6.4) compared to NA (45.9 ± 7.8) and PA (40.4 ± 5.8) regarding the direct effect; and significantly lower in VA (34.3 ± 7.1) and PA (37.8 ± 5.6) compared to NA (44.6 ± 6.2) regarding the preventive effect. In the preventive approach, mean wheal and flare size were significantly smaller in VA (0.38 ± 0.12 cm2/8.1 ± 2.0 cm2) compared to PA (0.54 ± 0.13 cm2/13.5 ± 2.8 cm2) and NA (0.73 ± 0.28 cm2/15.1 ± 4.1 cm2), and mean perfusion in VA (72.4 ± 10.7) compared to NA (84.1 ± 10.7). Mean EIQ ratings were significantly lower in VA compared to NA and PA in the treatment approach; and significantly lower in VA and PA compared to NA in the preventive approach. Conclusions: Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions. [Copyright &y& Elsevier]

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Integrative approaches have played an essential role in the treatment of dermatological diseases since a long time. Many current standard treatments can be considered integrative such as phototherapy, climate therapy (such as staying at high altitude or at the sea), special training on how to handle a disease, special diets and psychological approaches. Furthermore the amount of well-controlled studies on complementary medicine in the treatment of dermatological disorders has increased within the last years. Besides different therapies derive from natural remedies, such as fumaric acid or psoralene (used e.g. in the treatment of psoriasis). An example reflecting the integrative approach in dermatology is the treatment of atopic eczema—an inflammatory, chronically relapsing, non-contagious and pruritic skin disease. Amongst others it consists in rehydration, anti-inflammation, antisepsis, avoidance of trigger factors and anti-pruritic strategies. The large number of emollients currently used includes many naturally derived topical agents. Anti-inflammatory standard treatment with corticosteroids and calcineurin-inhibitors is complemented by e.g. phototherapy or topical usage of e.g. soaked black tea pads as further treatment options. In case of antimicrobial treatment a variety of natural agents such as tea tree oil, lemongrass and cinnamon oil proved a strong anti-bacterial effect. Due to their potency to induce contact allergies they are, however, not recommended; neither are antibiotics. Non-irritating antiseptics are the agents of choice. Avoidance of triggering factors includes amongst others staying at high altitude or at the sea as well as special diets and avoidance of allergens. Antipruritic treatment includes topical therapies with anesthetics and corticosteroids as well as cold showers. Within the last years some promising new approaches have evolved, which have to further be evaluated regarding its clinical effect on atopic eczema: Recent experimental studies have e.g. shown an effect of acupuncture on histamine- and allergen-induced itch and an influence of allergen-induced basophil activation. Sangre de grado, an Amazonian medicinal, showed to be a potent antimicrobial, anti-inflammatory and inhibitor of sensory afferent nerve mechanisms. Future studies will have to further focus on the role of integrative medicine in dermatology. [Copyright &y& Elsevier]

Background: Itch is a complex and unpleasant sensory experience that induces the urge to scratch and is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant positive effect on histamine-induced itch in healthy volunteers. Objective: We investigated the effect of acupuncture on allergen-induced itch, and wheal and flare response in a double-blind, randomized, placebo-controlled, crossover trial. Methods: A skin prick test (house dust mite or grass pollen) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches of conditioning or control observation: acupuncture at points Quchi and Xuehai (A1, dominant side), “placebo point” acupuncture (A2, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10min, wheal and flare size, as well as temperature, were measured at the stimulus site and the validated Eppendorf Itch Questionnaire (EIQ) was completed by the patient. Results: Mean itch intensity was significantly lower in A1 (35.7±6.4) compared to NA (45.9±7.8) and A2 (40.4±5.8) with regard to the direct effect; and significantly lower in A1 (34.3±7.1) and A2 (37.8±5.6) compared to NA (44.6±6.2) with regard to the preventive effect. Mean wheal and flare size was significantly smaller in A1 (0.38±0.12cm2/8.1±2.0cm2) compared to A2 (0.54±0.13cm2/13.5±2.8cm2) and NA (0.78±0.28cm2/15.1±4.1cm2) in the preventive approach. Skin temperature showed no significant difference between groups. Mean EIQ ratings were significantly lower in A1 compared to NA and A2 in the treatment approach; and significantly lower in A1 and A2 compared to NA in the preventive approach. Conclusions: Acupuncture at the correct points reduced allergen-induced itch intensity and prevented wheal and erythema formation compared to placebo procedures in patients with atopic eczema. [Copyright &y& Elsevier]