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Background:Few clinical trials have evaluated the efficacy and safety of Tripterygium wilfordii Hook F (TwHF) compared with acitretin in psoriasis.We aimed to compare the efficacy and safety of TwHF compared with acitretin in the treatment of moderate to severe psoriasis vulgaris.Methods:Adults with Psoriasis Area Severity Index (PASI) score ＞ 10 and psoriasis-affected body surface area ＞ 10％ were randomized into a TwHF (20 mg,3 times a day) or acitretin group (30 mg,once a day).The treatment course lasted for 8 weeks.Patients were assessed at baseline and at 2,4,and 8 weeks.Laboratory tests were performed at baseline,week 4,and week 8.The data were analyzed using paired samples t-test or analysis of variance (ANOVA).Results:A total of 115 patients was enrolled (58 TwHF; 57 acitretin).The median PASI score improved in the TwHF group by 50.4％ and in the acitretin group by 42.7％.There was no significant difference in median PASI improvement between two groups at 2,4,and 8 weeks.There was also no significant difference in PASI 25,PASI 50,PASI 75,and PASI 90 response between the two groups at 2,4,and 8 weeks.There was a significant increase in the level of aspartate transaminase and triglycerides in the TwHF group (P =0.026 and P =0.011,respectively).In the acitretin group,there was a significant increase in the level of alanine transaminase,cholesterol,and high-density lipoprotein (P =0.030,P ＜ 0.01,and P ＜ 0.01,respectively).Conclusions:There was no significant difference in treatment efficacy between the TwHF and acitretin groups within 8 weeks,but there were fewer treatment-related adverse events in the TwHF group.