Different acupuncture and moxibustion therapies for atopic dermatitis: a systematic review and network meta-analysis

Abstract Objective To investigate the effectiveness of different acupuncture and moxibustion therapies in improving symptoms in patients with atopic dermatitis (AD) to determine the optimal approach. This study aims to provide insights into clinical decision-making in the complementary and alternative management of AD. Study design Systematic review and Network meta-analysis. Materials and methods Randomized controlled trial (RCT) studies were retrieved from various databases, including PubMed, Embase, the Cochrane Library, Web of Science, CNKI, WANFANG Data, and VIP. The RoB 2.0 assessment tool was used to assess the risk of bias in the included studies. The meta-analysis was conducted via Stata 17 software. Results A total of 23 RCTs involving 1,658 participants were included. Compared with controls, traditional pairwise meta-analyses revealed that acupuncture and moxibustion therapies significantly improved the overall response rate (OR: 2.83, 95% CI: 2.05–3.89; I 2 = 43.7%, P = 0.025) and reduced the SCORAD score (SMD: –0.24, 95% CI: –0.37–0.11; I 2 = 0.0%, P = 0.784). Network meta-analysis further indicated that moxibustion, embedding needling, and fire needling showed a higher probability of clinical efficacy according to SUCRA rankings. However, considering the small sample sizes of certain trials and the reliance on indirect evidence, these results should be interpreted as preliminary evidence rather than definitive clinical superiority. Conclusions Acupuncture and moxibustion therapies appear to be effective in improving clinical outcomes in patients with atopic dermatitis, with moxibustion showing the greatest potential benefit. These findings support the therapeutic value of acupuncture-based interventions as adjunctive treatments for AD. However, further high-quality, large-scale randomized controlled trials are needed to confirm these results and to optimize clinical application strategies. Systematic review registration PROSPERO CRD42025632518.