Table 5 Studies included - dry needling or acupuncture for scar treatment

Dry needling or acupuncture as a monotherapy in case report studies (n = 5 of 8 case reports included)

Hunter 2011 [15] (Unspecified) CARE

ACU for keloid scar.

27-year-old female after repair of a Colles’ fracture to the left wrist

Keloid after repair of a Colles’ fracture/ left wrist/6 mos.

Non-specified

Non-specified

Sensitivity

Decrease of sensitivity, pain, thickness

Bintoro and Helianthi 2022 [22] (Indonesia) CARE

To determine the efficacy of a combination of BFA and local point ACU for post- laparotomy scar pain.

69-year-old female after laparotomy, with severe pain located in the area of laparotomy wound

Transverse post- surgical scar between the xiphoid process and the umbilicus/ 30 cm in length and 0.3 cm in width/4yrs.

NRS = 8/11

NRS = 0/11

dark brown and prominent, hardness of tissue along the scar area

changes of tissue color and hardness not reported

Huang et al., 2020 [25] (China) CARE

To present the effects of FNS for subcutaneous adhesions and scar hyperplasia in the neck region.

55-year-old male with impaired neck mobility and difficulty swallowing after tongue lesion resection (lymphadenectomy)

15 cm-long curved post-surgical scar in the neck region, surrounded by numerous scar tissues/8 yrs.

Not measured

Not measured

VSS = total 7 points (M1, V0, H2, P4)

Neck ROM: Ex = 38.83 ± 7.25, F = 30.67 ± 7.87; side bend: R = 27.83 ± 3.66, L = 26.00 ± 2.97; rotation: R = 54.83 ± 9.09, L = 53.67 ± 10.82

Cicatricose area with tightly connected scar tissues; other symptoms: affected muscle was tightened, cold, stiff, numb, painful

VSS = total 5 points (M1; V0; H2; P2).

Neck ROM: Ex = 41.83 ± 7.33, F = 38.83 ± 3.82; side bend: R = 33.33 ± 2.50, L = 28.33 ± 1.63; rotation: R = 58.33 ± 9.00, L = 62.67 ± 6.54

Reduced soreness, stiffness, cold, tingling, Dissociation of tissue adhesions beneath scars

Das and Khan 2019 [23] (India) CARE

To report the effects of DN on post-scar neuralgia

64-year-old male after hip surgery with pain along the anterolateral aspect of the left thigh

Surgical hip scar and post-scar neuralgia of the left thigh/8yrs.

Non-specified

Non-specified

Non-specified

Non-specified

Fang 2014 [24] (USA) CARE

To report the ACU effects on pain associated with scar tissue.

48-year-old female with stabbing pain in the scar area for 3 mos., sometimes alleviated by ice, and provoked by touch and pressure. Other symptoms: hot flashes, night sweats, dry eyes and photosensitivity; a pale purple tongue body with scallops; menopause at the age of 43 years

Surgical scar/upper right thigh/3 inches long and 1/4 inch wide/1 year.;

Likert Scale 7/10

Likert Scale 1–2/10

tough and hard, red color, very sensitive to touch

no change in toughness and hardness, probably less red in color

Combination of dry needling or acupuncture with other therapeutic modalities in case report studies (n = 3 of 8 case reports included)

Anderson 2014 [14] (Northern Ireland) CARE

To report the effects of local ACU on the degree of scarring and the ROM of fifth finger after surgical release of Dupuytren’s contracture.

26-year-old male who presented 5 weeks after surgical release of Dupuytren’s contracture of the little finger of his right hand

Keloid scarring over the fifth finger/ 5 weeks

Not measured

Not measured

Fixed F = 25^o at the PIPJ, thickness of tissue over the palmar aspect was palpable, altered sensation and numbness in the fifth finger; weakness of the hand extensors; reduced functional ability

Fixed F = 5 ^o at the PIPJ, the scar much softer and flatter, improvement in numbness and color in the fifth finger; changes in weakness of hand extensors and functional ability not reported

Tuck 2015 [26] (UK) CARE

To determine the effect of ACU on degenerative lower back pain and neuropathic scar pain.

54-year-old female with scar after metastatic breast cancer and degenerative lower back pain

Post-surgical scar on the chest (right mastectomy and axillary clearance)/4 mos.

scar pain VAS = 3–4/10

no improvement of scar pain VAS = 3–4/10 after superficial needling

Non-specified

Non-specified

Tuckey et al., 2022 [27] (Australia, New Zealand) CARE

To assess the effects of localized ACU for symptomatic scars in a patient with healed burn injury.

71-year-old caucasian male with hypertrophic scar, painful and itchy after burn injury and subsequent skin grafting

Burn scar/skin graft of left lateral thorax /3 mos. and minor burns to the fingers on his left hand

NRS = 7/10

NRS itch = 5/10

NRS = 4.5/10

Follow up NRS = 6/10

NRS itch = 4/10

Follow up NRS itch = 5/10

POSAS = 57/70 (81%)

SF-36 - Summary scores (%) PCS – 29, MCS-46

POSAS = 27/70 (38%), Follow up POSAS 33/70 (47%), SF-36 - patient declined to complete the questionnaire

Follow up SF-36-unable to complete over the phone

Combination of dry needling or acupuncture with other therapeutic modalities in Randomized Controlled Trials (n = 2)

Kotani et al., 2001 [28] (Japan) RCT

To determine if insertion of intradermal needles into painful points around scar tissue reduces scar pain.

n = 70 (30 M/40F): Tr group n = 23, 47yr ± 16; Sham tr group = 23,46yr ± 14; C group n = 24, 46yr ± 13.

Abdominal scar pain in and around the scar, after acute inflammation, detectable painful points, no satisfactory pain relief with conventional treatments

Surgical scar of abdomen/ at least 12 weeks,

Continuous and lancinating pain assessed using the VAS

Continuous pain - VAS reduction in more than 70% Tr group, lancinating pain - VAS = 0 in more than 40% Tr group, reduction of these parameters < 15% Sham Tr group, no significant pain reduction in C group

area of pain, pressure to initiate painful point pain (pain < = 2.5 kg/cm²), daily diclofenac consumption

area of pain: reduction in more than 70% Tr group; less than 15% Sham Tr group pain threshold pressure: increase in Tr group, decrease in Sham Tr group < 15%; daily diclofenac consumption: 70% decrease in Tr group cases, < 15% - Sham Tr group cases, 0% - C group

Song et al., 2011 [29] (China) RCT

To observe the clinical effects of ACU treatment for hypertrophic scar.

n = 80 (44 M/36F), 8–52 yrs. (mean 26 yrs.) with hypertrophic scars, unsmooth surface, congested red color and hard texture, with pain, burning painful, itching sensation or tight sensation

HS different degrees/42 cases-post-operative (chest and abdomen), 23 cases of post-injury scars (four limbs), 6 cases of face scars/ 3 mos. – 4 yrs.(mean 0.7 year.)

Itch assessment as the part of integral criteria

Itch assessment as the part of integral criteria of therapeutic effects

Criteria of therapeutic effects: cure, effect, failure.

Researchers’ own 3-point scale: 0–3 points for color, itching, hardness. Total scores: 56 of 80 scar sites were severe (9 points), 23 sites were moderate (6–9 points) and 15 sites were mild (1–5 points)

Criteria of therapeutic effects: cure: n = 31 Tr group, n = 23 C group; effect: n = 15 Tr group, n = 12 C group; failure: n = 3 Tr group, n = 10 C group; total effective rate: 93.9% Tr group, 77.8% C group statistically significant difference between the two groups (P < 0.01)

Combination of dry needling or acupuncture with other therapeutic modalities in case series study (n = 1)

Lubczyńska et al. 2023 [30] (Poland) Case series

To assess effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars

n = 11 (F)

32.9 year ± 5.2

Postoperative scar/elbow (n = 1), abdominal (n = 3), and CS (n = 7)/5 mos. (± 2.9)/One person was excluded from the study due to initiation of the other treatment.

PSAS

Patient scale

NRS = 5 (range 0–10)

PSAS

Patient scale

NRS ~ 1,5 (range 0–10)

Skin hydration mean = 37.8 ± 7.7 (Corneometer CM 825)

TEWL; Tewameter TM Hex) (g/m²/h) = 13 ± 4

Stretchability (mean = 0.003 mm ± 0.0003

Erythema level mean = 352.1 ± 103.1

Melanin in the scar tissue

POSAS pain, pruritus, color, stiffness, regularity and vascularization, and elasticity.

Skin hydration mean = 48.6 ± 1.2

TEWL (g/m²/h) mean = 9.7 ± 2.4

Stretchability (0.05 mm ± 0.01

Erythema level mean = 249.9 ± 89.8

Melanin = no change

POSAS = significant changes