Background:

Cupping Therapy (CT) has been reported as treatment for several skin conditions such as acne, post herpetic neuralgia, psoriasis, atopic dermatitis and urticaria. Although it is often considered as part of the Traditional Chinese Medicine (TCM), it has been widely practiced in the Middle East and the rest of the world for centuries. In Basra, a city in the southern part of Iraq, cupping therapy is often used by alternative medicine practitioners for treating skin disorders. However, limited is known about the clinical and histological effects of cupping therapy on the skin.

Objectives:

To investigate the immediate and delayed effect of CT on the skin, clinically and histologically.

Material and Methods:

TWe visited alternative and herbal medicine clinics that practice cupping therapy in Basra. Questionnaires were given to the patients and the alternative medicine practitioners to explore their experience with cupping therapy in terms of the presenting complaints and symptoms following therapy. The different types of application techniques and the immediate and delayed clinical changes on the skin following cupping therapy have been recorded. Ten skin biopsies were taken from male participants to investigate the histological changes in the application sites.

Results:

One hundred and thirty five patients were enrolled in the study. Of them, 102 (75.6%) were males and 33 (24.4 %) were females. The presenting complaints in males were back pain (29.4 %), Sciatica pain (15.7%) then headache (12.7%). In females, the presenting complaints were frozen shoulder (30.3%), back pain (18.2%), joint pain (12.1%) and gynecological causes (9.1%). Skin diseases were the presenting complaints in 4.9% of the males and 3% of the females. They included psoriasis, vitiligo, and eczema. Following cupping therapy, the immediate signs were erythema, swelling, bruising, bleeding, bullae formation and sings of cutting as results of cutting the skin for bloodletting. Patients reported discomfort ranging from slight tingling sensation to severe pain. Delayed clinical effects were scars in 6% of cases and patches of post inflammatory hyper-pigmentation with or without ring of ecchymosis in 4 % of total cases 30 days after cupping therapy. In all other cases complete healing of the skin was within three weeks. No adverse events were noted in our study. Histological changes following cutting and bloodletting were mild oedema, vacuolization and longitudinal fissure as a result of cutting in the epidermis. In the dermis, histological changes were dermal oedema and bleeding in the upper and lower parts of the dermis. No cellular infiltration was noted.

Conclusion:

Cupping therapy is associated with distinctive early and late clinical changes. However, it is safe procedure and most of these changes are reversible within three weeks. There were no adverse events as a result of the therapy. The efficacy of cupping therapy in treatment is beyond the scope of this study and further studies are needed.

Keywords: Cupping Therapy, Al-Hijamah