Treating steroid-dependent psoriasis from the blood-heat syndrome perspective: A case report

Psoriasis is a chronic, inflammatory dermatosis with a complex pathogenesis. Steroid-dependent psoriasis represents a therapeutic challenge, as conventional treatments often yield suboptimal responses and relapse. In traditional Chinese medicine (TCM), psoriasis is categorized as "Bai Bi," and the blood-heat syndrome is a core pathological pattern driving inflammation and progression. However, the efficacy of TCM strategies specifically targeting this syndrome in steroid-dependent cases requires further documentation.

A 68-year-old male presented with a 20-year history of recurrent, widespread erythematosquamous plaques, and severe, refractory pruritus. The condition had acutely exacerbated in the preceding week. Previous long-term therapies with topical corticosteroids and calcipotriol provided only transient improvement with frequent recurrence.

The patient was diagnosed with active-phase, steroid-dependent psoriasis (Western medicine). TCM syndrome differentiation identified a pattern of blood-heat with dampness-wind. Retrospective severity assessment estimated a psoriasis area and severity index score of 16.7 and body surface area involvement of 15%, indicating severe disease.

A stage-adapted TCM therapeutic strategy was employed, centered on a modified "Buffalo Horn and Rehmannia Decoction" (Shui Jiao Dihuang Tang). The core principle was to cool the blood, resolve toxins, and dispel dampness and wind. The prescription was dynamically adjusted across 3 clinical visits over 3 months based on symptom evolution, including dose modifications of key herbs like Buffalo Horn and the addition of agents to address pruritus, sleep disturbance, and residual hyperpigmentation.

Following the 3-month intervention, complete resolution of skin lesions and elimination of pruritus were achieved. The patient maintained clinical remission without recurrence during an 11-month follow-up period, based on self-report.

This case documents clinical improvement following TCM intervention in steroid-dependent psoriasis. Important limitations include the single-case design, lack of control group, retrospectively estimated psoriasis area and severity index/body surface area scores, and self-reported long-term outcomes. The observed temporal association between intervention and improvement may reflect natural disease variation, placebo effects, or other confounding factors. While this preliminary observation merits further investigation through rigorous prospective studies, the current evidence level remains limited and cautions against causal interpretation.