Acupuncture outperforms a popular topical medication for the treatment of melasma, . Researchers from Xiamen University Affiliated Hospital (Fujian, China) conclude that acupuncture is effective for the alleviation of melasma. In a randomized parallel study, the acupuncture treatment group achieved a total efficacy rate of 82.22% and the drug control group achieved an efficacy rate of 62.50%. Patients in the acupuncture treatment group received acupuncture needling on the Yangming meridians. Patients in the control group received oral administration of vitamin C and 3% hydroquinone topical cream. Hydroquinone is a cream used to lighten dark patches of skin. The researchers conclude that acupuncture significantly outperforms drug therapy for the treatment of melasma. The researchers highlight that “Acupoint selection at Yangming meridians for facial beauty enhancement has ancient historical roots, and acupuncture obtains satisfactory results for the treatment of melasma.” 
Melasma, also known as chloasma faciei, is a common skin problem that causes symmetric facial hyperpigmentation. Women are diagnosed more than men for melasma. The generally accepted female to male ratio of melasma is 9:1. 
Melasma is common during pregnancy and is exacerbated by sun exposure, which is why sunscreen is often recommended as a preventative measure. The National Institutes of Health estimates that 50–70 percent of pregnant women will have melasma.  Globally, melasma is responsible for a serious impact on patients’ appearance, causing psychosocial and emotional distress, and reducing quality of life.
A common treatment for melasma is hydroquinone, which works by lightning the skin when applied to the discolored skin patches.  While effective, the downside is that long-term use of the medication can cause chronic skin complications (e.g., ochronosis).  Acupuncture has an ancient and well documented history for the treatment of melasma that is both safe and effective. The study focuses on a comparison between drug and acupuncture treatments.
Researchers (Cao et al.) used the following study design. A total of 85 patients received acupuncture or drug treatments in this study. Patients were randomly assigned to a drug control group and an acupuncture treatment group respectively, with 40 and 45 patients in each group. The acupuncture treatment group was comprised of 3 males and 42 females, with an average age of 35.4 (±1.3) years and a melasma medical history of 36.7 (±1.9) months.The control group had 7 males and 33 females, with an average age of 34.9 (±2.1) years, and a melasma medical history of 35.1 (±2.4) months. The patients from both groups were comparable as there were no significant differences in terms of their gender, age, and medical histories when entering the study groups. Patients from the treatment group received acupuncture at the following primary acupoints:
A secondary set of acupuncture points was added dependent upon differential diagnostics in the Traditional Chinese Medicine (TCM) system. For qi and blood deficiency, the following acupoints were added with a reinforcing technique.
For qi and blood stagnation, the following acupoints were added with a mild reinforcing and reducing technique (ping bu ping xie):
For Yangming intestinal heat, the following acupoints were added with a reducing technique:
The acupuncture treatment was administered daily, except during menstruation. Each treatment course consisted of 30 acupuncture treatments followed by a 7 day break before the next course began. All patients received 2 treatment courses in total.
Patients from the control group consumed 100 mg of vitamin C tablets, three times a day. In addition, patients received 3% hydroquinone for topical use, twice per day. The drug therapy lasted for a total of 60 days (2 treatment courses).
After two courses of care, the acupuncture treatment group achieved an efficacy rate of 82.22%. A total of 15 patients were cured, 25 showed significant improvements, and 8 patients remained unimproved. The control group achieved an efficacy rate of 62.50%. A total of 3 patients were cured, 22 showed significant improvements, and 15 remained unimproved. The efficacy rates show significant differences between these treatment methods.
The researchers cited the ancient historical roots underlying the protocol used in the study. In TCM (Traditional Chinese Medicine), the Yangming meridians run through the head and face, covering the majority of melasma areas. The Ling Shu (The Miraculous Pivot) notes that “Yangming stomach meridian of foot starts from the [lateral side of] the nose, runs into the inner canthus where it meets Taiyang bladder meridian of foot, turns downwards along [lateral side of] the nose, and enters the upper gum. After reemergence, it curves around the lips and meets with the Conception Vessel at Chengjiang (CV24). It then runs posterolaterally across the lower portion of Daying (ST5). Winding along Jiache (ST6), it ascends along the jaw, passing through the front of the ear and Shangguan (GB3), it runs along the anterior hair line, finally reaching the forehead.”
TCM principles state that the Yangming meridians are more abundant in qi and blood compared with other meridians. After receiving acupuncture stimulation, this advantage can be magnified, accelerating the local qi and blood circulation and the clearance of melasma. Hegu (LI4), Tianshu (ST25), and Zusanli (ST36) are Yangming meridian acupoints. Hegu (LI4) is the Yuan-source point of the yangming large intestine meridian of the hand. This point is traditionally indicated for facial skin problems. The acupuncture classic Zhen Jiu Da Cheng (Great Compendium on Acupuncture and Moxibustion) dictates that “Hegu can be used for facial and oral problems.” Tianshu (ST25) is the Mu-front point of the large intestine meridian. Needling this point regulates qi and blood circulation. Zusanli (ST36) is a prominent acupoint used to tonify qi and blood for treatment of deficiency conditions.
The drug treatment regimen achieved significant results but with high potential risks of developing complications when used for the long-term. The acupuncture treatment did not have any serious adverse effects. In addition, the total efficacy rate and the cure rate were higher in the acupuncture group than in the drug group. The results indicate that acupuncture is an important treatment option for patients with melasma. To learn more, contact local licensed acupuncturists.
Notes  Cao QP. Yangming Meridian Acupuncture in the Treatment of Chloasma: A Randomized Parallel Control Study [J]. Journal of Practical Traditional Chinese Internal Medicine, 2013(4s):150-151.  Oluwatobi A, Ogbechie-Godec, Nada Elbuluk. Melasma: An Up-to-Date Comprehensive Review [J]. Dermatol Ther (Heidelb). 2017 Sep; 7(3): 305–318.  Rashmi Sarkar, Pooja Arora, Vijay Kumar Garg, Sidharth Sonthalia, and Narendra Gokhale. Melasma update [J]. Indian Dermatol Online J. 2014 Oct-Dec; 5(4): 426–435.  aad.org/public/diseases/color-problems/melasma#treatment  Nordlund, J. Grimes, P. and Ortonne, J. The safety of hydroquinone [J]. Journal of the European Academy of Dermatology and Venereology, 2006, 20: 781-787.