“Cupping” With Pain


"Cupping," as medical therapy, was first described in ancient texts 3000 to 4000 years ago. The application of cups to the patient’s skin was intended to draw out substances (eg, toxins and fluids) inside the body that were believed to cause a variety of ailments. Though its use has long since been discarded in mainstream medicine, it is still used routinely in both Chinese and alternative medicine.

Cupping has been evaluated by numerous medical individuals and organizations, who uniformly dismiss any benefit it might offer, even as a placebo. From a pathophysiologic standpoint, cupping causes localized dilation of blood and lymph vessels, thus creating telangiectasia that, as they resolve, leave behind postinflammatory hyperpigmentation and edema. (Excessive production of telangiectasia might indicate pathologic capillary fragility, possibly secondary to Rumpel-Leede phenomenon.)

The patient's skin type can affect the rate of resolution (longer for those with darker skin, shorter for those with fair skin); there is little we can do to speed up this process. Although the case patient was disappointed with the lack of available treatment for her blemishes, she was insistent about continuing the cupping therapy.

Interestingly, there is a differential diagnosis for such lesions; it includes injury from tennis balls, racquetballs, paintballs, or even baseballs—though the associated lesions are usually solitary.


  • Cupping, as medical therapy, has been around for thousands of years and is still routinely used in both Chinese and alternative medicine.
  • The intention of its use is to draw out noxious substances that purportedly cause the patient's complaint—however, according to numerous medical authorities, the practice is totally ineffective.
  • The suction effect of cupping induces edema and telangiectasia, which in turn results in postinflammatory hyperpigmentation that clears slowly.
  • Similar lesions can result from being struck by paintballs, racquetballs, tennis balls, and baseballs.


Recommended Reading

Rash on elbows and hands
Clinician Reviews
Baby’s Rash Causes Family Feud
Clinician Reviews
Expert shares contact dermatitis trends
Clinician Reviews
Hadlima approved as fourth adalimumab biosimilar in U.S.
Clinician Reviews
Biologics for pediatric psoriasis don’t increase infection risk
Clinician Reviews