Clinical heterogeneity in psoriasis and the predictive efficacy of traditional Chinese medicine: A multi-center real-world study.

OBJECTIVE

This multi-center, real-world study aimed to characterize the clinical profiles of different traditional Chinese medicine (TCM) syndromes and assess the associated treatment outcomes, including efficacy, safety, and predictive factors.

METHODS

Psoriasis patients with blood-heat syndrome (BHS), blood-stasis syndrome (BSS) and non-BHS/BSS were included. Data on demographics, lifestyle, comorbidities, disease severity, and TCM constitutions were collected. Patients received syndrome-specific oral Chinese herbal medicines. Multiple linear regression identified efficacy predictors for the reduction in psoriasis area and severity index (PASI) scores at week 8.

RESULTS

This study included 689 psoriasis patients with BHS, 319 with BSS, and 349 with non-BHS/BSS. BHS patients were younger and more highly educated, while BSS patients preferred spicy food, smoked more, and carried a heavier comorbidity burden. Following 8 weeks of treatment, all groups showed similar reductions in PASI scores (P = 0.07) and comparable increases in the proportion of participants with the yin-yang harmony constitution. Patients in the BSS group, however, had a superior improvement in their dermatology life quality index (DLQI) score and their visual analog scale (VAS) score for pruritus (all P < 0.05). Key predictors of PASI improvement included baseline PASI score (β = 0.59, P < 0.001), female sex (β = 0.57, P = 0.004), baseline VAS score (β = 0.11, P = 0.02) and body mass index (β = -0.08, P = 0.007), explaining 58.9% of the outcome variance (R2 = 0.589). Treatment-related adverse events occurred in only 3.54% of cases and recurrence rates at week 16 remained below 5.02%.

CONCLUSION

This study has not only clarified syndrome heterogeneity and validated the treatment system but also laid the groundwork for probing into the biological underpinnings of TCM syndromes. Please cite this article as: Sun XY, Zhou YQ, Liu L, Wei L, An YP, Weng HL, Ji YR, Guo S, Zhou WL, Hu WT, Wang JF, Fang YM, Zhao YD, Li JW, Zhu KB, Hu RY, Hu SY, Hu CX, Liang N, Yang CY, Jing FY, Zhang Y, Li X, Li B. Clinical heterogeneity in psoriasis and the predictive efficacy of traditional Chinese medicine: A multi-center real-world study. J Integr Med. 2026; Epub ahead of print.