Comparative Effectiveness and Safety of Acupuncture-Related Therapies for Psoriasis Vulgaris: An Updated Systematic Review and Network Meta-Analysis

Background/Objectives: A previous network meta-analysis of acupuncture-related treatments for psoriasis was based on searches completed in 2016 and grouped several distinct techniques into broad treatment categories. Since then, substantial randomized evidence has accumulated. We therefore updated the evidence and compared the effectiveness and safety of distinct acupuncture-related therapies for psoriasis vulgaris. Methods: Nine Chinese and international databases were searched from inception to March 30, 2026 for randomized controlled trials. Risk of bias was assessed using RoB 2, and certainty of evidence for the primary outcome was evaluated with CINeMA. A frequentist network meta-analysis was performed, and treatment rankings were estimated using SUCRA. Results: Thirty-three RCTs involving 2711 participants were included. For post-treatment PASI, significant reductions compared with WM were observed for MA + WM (SMD −2.44, 95% CI −4.85 to −0.03), MA + CHM (−1.79, −3.19 to −0.39), FN (−1.77, −3.17 to −0.37), and FN + CHM (−1.74, −2.55 to −0.93); however, all corresponding 95% prediction intervals crossed the prespecified equivalence range, and CINeMA rated these comparisons as very low certainty. Statistically significant favorable estimates were also observed for total response rate with MA + WM, FN, FN + CHM, and MWA + CHM; for DLQI with FN, FN + CHM, MA + CHM, and MOX; and for Pruritus Score with MWA + CHM, FN, FN + CHM, and MA + CHM. Some regimens showed lower reported odds of adverse events than WM, although safety estimates were based on sparse events and several zero-event arms. Post hoc sensitivity analyses retained the direction of several key effects, although some rankings and the MA + WM comparison were sensitive to alternative node definitions. Conclusions: Several acupuncture-related monotherapies and add-on regimens showed favorable effects across clinically relevant outcomes, but no single treatment was consistently superior. Interpretation remains limited by heterogeneity, inconsistency in some secondary outcomes, and very low certainty of evidence for PASI.