BACKGROUND: There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment. OBJECTIVE: The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture. SEARCH STRATEGY: The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. INCLUSION CRITERIA: The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. DATA EXTRACTION AND ANALYSIS: The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results. RESULTS: As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous. CONCLUSIONS: The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation. SYSTEMATIC REVIEW REGISTRATION: INPLASY no. 202310058.

Department of Biophysics Faculty of Medical Sciences in Zabrze Medical University of Silesia Jordana 19 street Zabrze 41 808 Poland

Department of Medical Biophysics Faculty of Medical Sciences Medical University of Silesia Medyków 18 street 40 752 Katowice Poland

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol Prague 5 Úvalu 84 Prague 5 150 06 Czech Republic

Electromyography and Pelvic Floor Muscles Laboratory Department of Physical Medicine Institute of Physiotherapy and Health Sciences Academy of Physical Education in Katowice Mikołowska 72 street Katowice 40 065 Poland

Institute of Physiotherapy and Health Sciences Academy of Physical Education in Katowice Mikołowska 72 street Katowice 40 065 Poland

Institute of Physiotherapy and Health Sciences Department of Physiotherapy in Internal Diseases Academy of Physical Education in Katowice Mikołowska 72 street Katowice 40 065 Poland

Institute of Sport Sciences Academy of Physical Education in Katowice Mikołowska 72 street Katowice 40 065 Poland

Physiotherapy Department Faculty of Physical Education and Sport Charles University Prague José Martího 31 Prague 6 162 52 Czech Republic

Students Scientific Association IMPULSE of the Institute of Electromyography and Pelvic Floor Muscles Laboratory Department of Physical Medicine Physiotherapy and Health Sciences Academy of Physical Education in Katowice Mikołowska 72 street Katowice 40 065 Poland

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