Short Practical Regimen of Acupuncture for Melasma: A Prospective Cohort Study in a Tertiary Hospital in Thailand

BackgroundMelasma is a common skin pigmentation disorder. Acupuncture shows benefits for patients with melasma, although no standardized method or an optimal number of sessions have been determined. ObjectiveTo comparatively assess clinical outcomes of melasma between five versus ten standard acupuncture sessions. MethodsWe performed a prospective observational cohort study in all melasma patients at the Acupuncture Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. All patients were treated with acupuncture procedures twice a week and were evaluated after the fifth and the tenth sessions of acupuncture, with a one-week follow-up after the last session. Participants were divided into two treatment groups: Groups A and B received five and ten acupuncture sessions respectively. Melasma outcomes were assessed by using the Melanin Index (MI), Melasma Area and Severity Index (MASI), patient-reported improvement scores, and acupuncture-related adverse events. ResultsOf 113 participants, 67 received five sessions of acupuncture treatment while 39 received ten sessions. 7 participants did not finish treatment. At one week after five sessions of acupuncture in Group A, the mean MI decreased by 28.7 (95%CI -38.5 to -18.8, p<0.001), whereas the median MASI decreased by 3.4 (-6.9, -1.2), p<0.001) points. At one week after ten sessions of acupuncture in Group B, the mean MI decreased by 31.3 (95%CI -45.0 to -17.6, p<0.001), whereas the median MASI decreased by 5.4 (-9.9, -3.0), p<0.001) points. The first five sessions of acupuncture had a higher effect on the change in magnitude than the last five sessions, although there was no statistically significant difference. Twenty-nine participants reported minor side effects, mostly consisting of persistent pain and small hematoma. Group B had a risk ratio (RR) of having adverse events 1.8 times (95% CI 1.0-3.4, p-value = 0.05) compared to group A. ConclusionShort acupuncture regimen of 5 to 10 sessions in melasma seems to be effective, practical, and high patient satisfaction with minor side effects. Summary BoxO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIAcupuncture has effectively improved melasma condition at low cost with minimal side effects. C_LIO_LITraditionally, one acupuncture course comprises of 10 sessions for a chronic condition but dose-response evidence of acupuncture for melasma has been lacking. C_LIO_LINumber of acupuncture sessions performed in various randomized controlled trial varied from 21 to 60 over 4-16 weeks. C_LI What are the new findings?O_LIFive sessions of acupuncture improved Melanin Index (MI) by 28.7 and Melasma Area and Severity Index (MASI) by 3.4 points. C_LIO_LITen sessions of acupuncture improved MI by 31.3 and MASI by 5.4 points, of which the improvement was mainly from the first five sessions. C_LIO_LIShort acupuncture regimen of 5 to 10 sessions in melasma seems to be effective, practical, and high patient satisfaction C_LI How might it impact on clinical practice in the foreseeable future?O_LIDose-response study has not been common but could have clinical and financial implications. C_LI