A 17-year-old presents for evaluation of acne. He plays three sports in high school and currently is participating in baseball. During examination, an incidental finding reveals circular, ecchymotic lesions on his back and flank.
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Cupping therapy is an ancient modality used to treat various medical conditions.1 Cupping involves creating suction with a ceramic, bamboo, plastic, or glass cup pressed against the skin. The application of a flame to the cup removes oxygen to create negative pressure; this can also be achieved with a suction device.2 The 2 most common types of cupping are wet and dry. Wet cupping consists of lacerating the skin during the procedure, whereas dry cupping draws the skin into the cup without lacerations, scarification, or blood. Cupping therapy is used in Middle Eastern countries as adjunctive therapy for psoriasis, atopic dermatitis, acne, urticaria, and postherpetic neuralgia.3 Cupping advocates in the United States and Europe believe that the procedure enhances athletic endurance.
The precise mechanism of action is unknown, although enhanced blood circulation, increased muscle oxygenation, immunologic effects, and release of toxins have been proposed.1 A placebo effect cannot be discounted.4,5 There are limited data surrounding histologic changes associated with cupping therapy, and randomized controlled trials are lacking.2,3
Distinctive clinical findings of circular, ecchymotic macules are diagnostic. These resolve in approximately 3 weeks. Cupping therapy is a safe procedure with no associated serious adverse events.
Lauren Ax, MSPAS, PA-C, is a physician assistant on staff at the DermDox Center for Dermatology in Hazleton, Pennsylvania, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
1. Al-Bedah AMN, Elsubai IS, Quereshi NA, et al. The medical perspective of cupping therapy: effects and mechanisms of action. J Tradit Complement Med. 2018;9(2):90-97.
2. Rodriguez T. Exploring the use of cupping in dermatology. Clinical Advisor website. https://www.clinicaladvisor.com/home/topics/dermatology-information-center/exploring-the-use-of-cupping-in-dermatology/. Published April 19, 2019. Accessed May 17, 2019.
3. Al-Rubaye KQA. The clinical and histological skin changes after the cupping therapy (Al-Hijamah). J Turk Acad Dermatol. 2012;6(1):1261a1.
4. Ahmadi A, Schwebel DC, Rezaei M. The efficacy of wet-cupping in the treatment of tension and migraine headache. Am J Chin Med. 2008;36(1):37–44. 5. Ahmedi M, Siddiqui MR. The value of wet cupping as a therapy in modern medicine – an Islamic Perspective. Webmed Cent. 2014;5:12.