European Review for Medical and Pharmacological Sciences 2021; 25: 2327-2330

The good and the bad of cupping therapy: case

report and review of the literature
M. VACCARO1, M. COPPOLA1, M. CECCARELLI2,4, M. MONTOPOLI3, C. GUARNERI4
1
Department of Clinical and Experimental Medicine, Section of Dermatology, University
of Messina, Messina, Italy
2
Department of Clinical and Experimental Medicine, Section of Infectious Diseases, University
of Catania, Catania, Italy
3
Department of Pharmaceutical and Pharmacological Sciences, University of Padua,
Padova, Italy VIMM – Veneto Institute of Molecular Medicine, Fondazione per la Ricerca
Biomedica Avanzata, Padua, Italy
4
Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Section of
Dermatology, University of Messina, Messina, Italy

Abstract. – Cupping therapy (CT) represents Case Report

a cornerstone of traditional Chinese and Persian A 31-year-old man was referred to our clinic for
medicine, but it has its roots in the history of a tele-dermatology consultation. He complained
therapy. Although its exact mechanisms of ac- of many annular ecchymotic lesions on his right
tion have been not fully understood, it is widely
used as an alternative or complementary treat-
shoulder (Figure 1). The patient was positive for
ment of a broad spectrum of diseases, main- type II diabetes mellitus and hypertension and
ly musculoskeletal pain and muscular tension. reported a previous history of cutaneous mycosis
Some practitioners use CT to cure dermatoses, fungoides.
but the most common adverse events occur at Dermatologic examination revealed painless,
the skin level. We describe a case and briefly re- multiple hemorrhagic vesiculobullous patches,
view the related literature. with a maximum diameter of 40 mm, located
over the upper thorax, anterior axilla and shoul-
Key Words:
Alternative medicine, Cupping, Negative pressure,
der.
Dermatosis, Differential diagnosis. His clinical history showed a previous episode
of a pustular skin rash on the posterior scalp ex-
tending to the posterior right neck and shoulder.
This episode occurred about three months before
and a diagnosis of herpes zoster was made. The
Introduction patient underwent a one-week treatment with va-
lacyclovir, showing a prompt improvement.
Complementary and Alternative Medicine He also underwent blood tests, which high-
(CAM) includes a wide variety of different sub- lighted a normal blood count, normal erythrocyte
stances and practices that are used, respectively, sedimentation rate, C-reactive protein and liver
instead of or together with conventional thera- and kidney functionality markers.
pies1. CAM spreads from the Eastern countries, Although the rash improved on treatment, fur-
such as China and Japan, to Western ones during ther investigations allowed to find out that the pa-
the last decades2. tient still suffered from shoulder pain. Moreover,
Despite their popularity, some concerns have movements were severely limited despite the use
arisen. These concerns are mostly due to the of analgesics and gabapentin.
lack of adequate knowledge by physicians, which He, therefore, underwent some courses of CT.
consequently leads to poor communication with CT consists in putting cups on skin, after disin-
practitioners and patients. Lack of knowledge fection of the area, and applying negative pres-
is also a cause of negative outcomes and wrong sure using a suction pump. The cups are removed
clinical management3. after 3-5 minutes, then re-attached under mild

Corresponding Author: Claudio Guarneri, MD; e-mail: [email protected] 2327

 M. Vaccaro, M. Coppola, M. Ceccarelli, M. Montopoli, C. Guarneri

Figure 1. A, Multiple symmetric annular ecchymotic patches on the right shoulder. B, Hemorrhagic vesicles within the lesion
(particular).

suction for other 5 to 10 minutes. Surprisingly, complement system, which increases the levels of
after some time, during a CT performed five days interferon and tumor necrosis factor. This might
before the appearance of the annular ecchymotic explain positive outcomes in patients with auto-
lesions for which he was referred to our center, immune diseases7.
he complained of pain, and the following day In addition, CT may stimulate pain receptors
hemorrhagic vesicles appeared. Annular lesions with the increase of the frequency of impulses
completely healed in two weeks using mometa- and the ultimate closure of the pain gates, leading
sone furoate ointment twice a day. to pain relief (Pain-Gate Theory)5,7.
Because of these potential properties, CT in
all its varieties (dry, wet, needle, herbal/bamboo,
Discussion water, moving and pulsatile) has been used in
several dermatologic diseases and related symp-
CT is used in alternative traditional Chinese toms, including post-herpetic neuralgia, chronic
and Persian medicine for the treatment of a broad idiopathic urticaria, psoriasis and psoriatic arthri-
range of conditions4-6. Although it has been used tis, acne vulgaris, erysipelas and eczema8.
all around the World for centuries, probably since However, a systematic review of the available
ancient Egypt, the exact mechanism of action studies performed by Soliman et al8 in 2018 re-
remains obscure despite an increasing number of vealed that there is only a theoretical value of CT
studies and meta-analysis6. in these conditions, in absence of randomized
The latest studies hypothesize that CT might clinical trials and robust data. More recent stud-
cause the release of Nitric Oxide (NO) from ies, focused on psoriasis, neurodermatitis and
endothelial cells. Therefore, it might induce an- chronic idiopathic urticaria, yielded similar re-
ti-inflammatory effects and an increased vascu- sults, as they were conducted in countries where
larization. Moreover, CT seems able to stimulate standard and alternative treatments were carried
local inflammation at first, then it activates the out together9-11.

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 The good and the bad of cupping therapy: case report and review of the literature

Table I. Summary of case reports with demographics, reason of CT and cutaneous reaction.

Reference Sex Age Reason of treatment Type of cutaneous reaction

Mataix et al12 M 65 Polymyalgia rheumatica Ecchymotic lesions

Studdiford et al13 F 32 Chronic neck pain Ecchymotic lesions
Lin et al14 M 55 Physiotherapy during flight Blisters, ecchymotic lesions
Kim et al18 F 77 Lumbar stenosis Hyperpigmentation
Yu et al22 M 40 Plaque psoriasis Koebner phenomenon, ecchymotic lesions and
purpura within the psoriatic lesions
Lee et al19 F 26 Chronic back pain Hyperpigmentation
Turtay et al20 M 51 Lumbar stenosis Lumbar abscess
Lee et al21 F 59 Constipation Chronic cutaneous ulcer (by Mycobacterium
massiliense)
Benli1 and Aktas5 M 56 Back and neck pain Vesicobullous lesions
Kluger and Fraslin16 M 39 Lumbar discal hernia Ecchymotic lesions
Pichler et al17 M 57 Hailey-Hailey disease Erythematous lesions with scattere
papulovesicular eruptions and crusted erosions
on the back

On the contrary, there are a lot of reports of cu- References

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Conflict of Interest
way or a unique entity dependent on insulin resis-
The Authors declare that they have no conflict of interests. tance? J Eur Acad Dermatol Venereol 2006; 20:
478-480.
  7) Al-Bedah AMN, Elsubai IS, Qureshi NA,
Funding Aboushanab TS, Ali GIM, El-Olemy AT, Khalil
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script. spective of cupping therapy: effects and mecha-

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