Herbal Medicine for Post-Vaccination Psoriasis Exacerbation: A Case Report and Treatment Outcome 疫苗接种后银屑病加重的中药治疗：病例报告与疗效观察

Patient Profile

A 55-year-old male with a one-year history of palm psoriasis initially achieved significant improvement after receiving three intralesional corticosteroid injections from a dermatologist. However, psoriatic lesions reappeared at the prior site of involvement on his palms shortly after he received his third dose of an mRNA-based COVID-19 vaccine. In an attempt to control the flare, the patient resumed topical corticosteroid therapy and began taking cordyceps-based health supplements. Despite these efforts, the rashes not only recurred but also spread from both palms to his forearms, accompanied by swelling of both palms. This exacerbation prompted him to seek a third medical opinion at our TCM clinic. The patient had no significant comorbidities, and his medical history was negative for autoimmune diseases or immunosuppressive therapy.

Initial Presentation

Physical examination revealed symmetrical, widespread erythema on both palms and forearms, ranging from dull red to light pink, indicative of chronic inflammation. Silver-white scaling was prominent, consistent with hyperproliferative epidermis typical of psoriasis. Both palms exhibited edema, particularly on the dorsal surfaces and periarticular regions, with wholearm involvement. The skin was dry, rough, and demonstrated delayed blanching, suggesting chronicity and possible eczematous overlap. No joint involvement or systemic symptoms were noted. Baseline blood chemistry, including liver and renal function tests, was normal.

Tailored TCM Intervention

He commenced treatment with TANGS herbal medicine, a compound formula taken orally twice daily, along with topical application of HLQ ointment. Treatment aimed to clear heat, resolve dampness, and normalize immune responses per TCM principles. The patient was advised to avoid common psoriasis triggers including psychological stress, alcohol consumption, hot baths, and to refrain from using both topical and systemic immunosuppressants during treatment, to discontinue cordyceps. Monthly photographic documentation and annually blood chemistry monitoring were implemented to track progress and safety.

Clinical Progress

Throughout the course of herbal treatment, the psoriatic rash followed a cyclical “wave-like” recovery pattern. During the initial 2 to 5 months of treatment, the patient experienced a transient exacerbation: the lesions expanded, thickened, and became more dry, itchy, and scaly, with occasional serous exudation, potentially reflecting an immune-modulatory adjustment phase. However, as treatment continued, symptoms gradually improved. The plaques became thinner, itching reduced, scales became finer, and oozing subsided.

By months 7 to 10, the condition stabilized, though a mild rebound flare occurred—less severe than the initial flare. With sustained therapy, the patient’s immune response gradually normalized, leading to complete lesion resolution. By the end of the course, the skin had returned to a smooth, healthy state, and the patient reported no adverse effects from the herbal medications.

Outcome

Phone call follow-up at 8 months confirmed sustained remission without recurrence. Blood chemistry remained normal, indicating no hepatic or renal toxicity from the TCM regimen.

You can find the full recovery footage for this case on our video channel.

Discussion

The global COVID-19 vaccination effort has played a pivotal role in controlling viral transmission. However, an increasing number of case reports have emerged documenting new-onset or exacerbation of immune-mediated skin diseases—notably psoriasis and eczema—following vaccination [1–31].

This case illustrates a successful therapeutic outcome using herbal medicine for a patient whose psoriasis relapsed and worsened after COVID-19 vaccination. Although the patient experienced an initial flare-up during the early stages of treatment, he ultimately achieved full disease remission through sustained herbal therapy. The cyclical recovery pattern suggests an adaptive immune response, possibly modulated by TCM’s properties.

Importantly, this case highlights the potential of alternative medical approaches, such as TCM, especially in situations where conventional treatments are insufficient or cause dependency. It underscores the need for individualized treatment strategies that respect both immune dynamics and long-term safety. To advance the field, future research should integrate TCM with immunological studies and controlled trials to establish its efficacy and mechanisms rigorously. Clinicians should approach such cases with caution, balancing the promise of alternative therapies with the need for evidence-based practice.

Privacy

In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.

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