An Unusual Skin Allergy Post Wet Cupping

Abstract

Cupping is one of the oldest natural healing therapies worldwide and is well known as a complementary treatment and remains in use for many ailments, including dermatological conditions. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. I report a case who presented with an interestingly allergic skin reaction post cupping on her back. Using search words of "cupping," "complication," and "skin allergy", did not yield any reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports due to poor clinical evidence. I am reporting this case report for its exceptional presentation. INTRODUCTIONCupping is a form of complementary and alternative medicine (CAM) that is used in the Muslim world, as well as in North Africa, the Far and Middle East, Eastern Europe and Latin America. It is proposed to be used initially by the ancient Egyptians, Greeks and Chinese and it is dated back to nearly 200 AD.The technique involves the application of ignited alcohol-soaked cotton in a glass cup or jar. The container is then applied to the skin over the area of interest. The area of skin can either be left as is (dry cupping) or it may be scratched and otherwise incised with a sharp object, such as a knife (wet cupping).The cup is left over the site and on cooling, generates a partial vacuum. This is said to draw "spoiled stagnant blood and toxins" and other "contaminants" as well as eliminating sluggish flow which manifest in the skin surface as a bruise. Moreover, cupping is performed over acupuncture spots in the belief that this stimulates the body's vital energy. CLINICAL PRESENTATIONA healthy Libyan lady in her 30s presented with acute itchy red beefy, non scaly, non oozing skin lesions over her back, mainly over both shoulders girdles and lower mid back for the last three days (Figure 1, 2, and 3). She gave a history of wet cupping performed by a pious woman in a medical clinic, and was not her first time to have it done for a pain she has on her lower back. She claimed that the skin allergy developed straight away after the session and the only thing her medic applied was an olive oil as a moisturizer after the cupping session. She did not follow up on treatment though the call centre of the hospital called her many times to come for a follow-up, but never replied back and thus dropped out.She was reporting bad backache and seeking complementary treatment (Figure 1), which resulted in multiple red, well-defined, rounded red skin lesions over the shoulders and lower mid back. She never came back for a follow up as instructed.On examination, there are multiple red, blanchable erythematous, well-defined, rounded none oozing red skin lesions over both shoulders girdle and the lower mid back at the exact places where the cupping was applied. A punch 4 mm was taken and sent for histopathology which revealed findings coincides with sub-acute spongiotic dermatitis. CASE REPORT An Unusual Skin...