Cupping-related skin lesions.

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling (i.e., kwashiorkor, intestinal parasitosis), on the abdomen (figure 5). The clinical pictures initially diagnosed as dermatophytoses or lesions caused by traumas or violence were later proved to be cupping-related outcomes or complications.