The Impact of Adjunct Fire Needle Therapy on Cytokine Expression in Patients with Acne

An assessor-blinded, randomized controlled trial evaluated the efficacy and potential mechanisms of fire needle therapy as an adjunct to standard topical treatment in patients with moderate acne.¹ Fire needle therapy is a traditional Chinese external treatment that involves rapidly inserting and removing a heated needle to enhance blood circulation, promote pus drainage, accelerate wound healing, and support tissue regeneration. It has been used as an adjunctive treatment for other skin conditions, including herpes zoster, psoriasis, and vitiligo.²

Clinical Efficacy and Visual Outcomes

The present study enrolled 47 participants aged 18 to 35 years with grade II or III acne and randomly assigned them to receive either fire needle therapy combined with topical adapalene and fusidic acid (n = 25) or topical therapy alone (n = 22) over an 8-week period. Outcomes included clinical severity assessed by the Global Acne Grading System (GAGS), standardized photography, and serum levels of inflammatory cytokines, including IL-8, IL-36, and thymic stromal lymphopoietin (TSLP).

Both cohorts experienced significant improvement in acne severity over time, as reflected by reductions in GAGS scores. However, the trajectory of improvement differed between groups. Patients receiving fire needle therapy demonstrated greater reductions in acne severity by week 8. While there were no significant differences between groups at baseline or at week 4, the combination therapy group achieved significantly lower GAGS scores at week 8, with a large effect size. Photographic assessments supported these results, showing greater reductions in inflammatory lesions, papules, and pustules, along with improvements in erythema, in the combination therapy group.

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Immunologic Mechanisms and Cytokine Regulation

The research also explored potential immunologic mechanisms underlying treatment effects. At baseline, patients with acne exhibited significantly elevated serum levels of IL-8, IL-36, and TSLP compared with healthy controls, supporting the role of systemic inflammation in acne pathogenesis. Following treatment, reductions in IL-36 and TSLP were significantly greater in the fire needle group compared with the control group. In contrast, although IL-8 levels decreased in both groups, the difference between groups was not statistically significant.

The observed cytokine changes provide insight into possible mechanisms of action. IL-36 is a proinflammatory cytokine involved in immune signaling and amplification of inflammatory pathways, while TSLP is associated with type 2 immune responses and has been implicated in sebaceous gland activity and skin inflammation. The greater reduction of these cytokines in the fire needle group suggests that the therapy may exert anti-inflammatory effects by targeting specific immune pathways relevant to acne.

Safety Profile and Adverse Events

In terms of safety, both treatment groups experienced mostly mild to moderate adverse events, including pain, burning sensation, erythema, and desquamation. These reactions were generally transient and did not interfere with daily activities. However, adverse events were more frequent in the fire needle group, including higher rates of pain and localized reactions such as swelling and slight bleeding. Notably, two cases of postinflammatory hyperpigmentation and one case of mild hypertrophic scarring were reported in the combination therapy group. No serious adverse events or infections were observed.

The study does have several limitations, including a relatively small sample size, short duration of follow-up, single-center design, and the lack of patient blinding. The authors also noted that the subjective nature of GAGS scoring may introduce some variability in clinical assessment.

Future Research

Overall, the findings indicate that fire needle therapy may provide additional clinical benefit when combined with standard topical treatments for moderate acne. The results also suggest that its mechanism may involve the downregulation of specific inflammatory cytokines, particularly IL-36 and TSLP. Further large-scale, placebo-controlled studies with longer follow-up are needed to confirm these findings and better define the role of fire needle therapy in acne management.

References

1. Wang R, Wang X, Wang N, Liu L. Efficacy and Potential Mechanisms of Fire Needle Therapy for Moderate Acne: An Assessor-Blinded, Randomized Controlled Trial. Dermatologic Therapy. 2026, 2839983, 9 pages, 2026. https://doi.org/10.1155/dth/2839983

2. Song Y, Shen L, Fu Y, et al. Visual analysis on clinical randomized controlled trial of fire needle based on VOSviewer and CiteSpace. 基于VOSviewer与CiteSpace的火针临床随机对照试验研究可视化分析. Zhongguo Zhen Jiu. 2024;44(2):231-238. Published 2024 Feb 12. doi:10.13703/j.0255-2930.20230321-0004