Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy

Abstract

Erythrodermic psoriasis (EP) is the most serious type of psoriasis with high morbidity and mortality. First-line recommended therapies for EP, cyclosporine and infliximab have significant adverse effects. Cyclosporine increases the risk of hypertension, leucopenia, infections and renal failure. Infliximab increases the risk of reactivation of tuberculosis, hepatitis B and histoplasmosis, and increases risk for hepatitis, autoantibody formation, congestive heart failure, demyelinating disorders, pancytopenia, lymphoma and skin cancer. An effective drug with a much safer side effect profile will be of significant benefit in EP. The phosphodiesterase 4 inhibitor apremilast is U.S Food and Drug Administration (FDA) approved for plaque psoriasis and psoriatic arthritis. Adverse effects of apremilast reported are headache, nausea, diarrhoea, upper respiratory tract infection, potential for depression and weight loss. We report complete and long-standing resolution of EP with first-line apremilast monotherapy. Apremilast may be an effective option with comparatively minor side effects for EP.

Apremilast efficacy and safety in elderly psoriasis patients over a 48‐week period

“…Interestingly, positivity of BerEP4 in MCC tumour cells was recently emphasized in the new WHO classification of skin tumours, 2 suggesting BerEP4 positivity as a potential pitfall in distinguishing BCC and MCC. However, in the literature, only 4 studies with a limited number of cases investigated EpCAM expression in MCC using various antibody clones [6][7][8][9] (Table 1).…”

Updates on the Treatment of Erythrodermic Psoriasis

“…Apremilast, a phosphodiesterase 4 (PDE4) inhibitor, has been used for EP in four case reports. [112][113][114][115] Papadavid et al reported one case of a previous failure with MTX, cyclosporine and adalimumab, who achieved PASI 100 after apremilast 30 mg twice daily for 20 days. 112 Krishnamoorthy et al reported one case with the total resolution of the lesions after 10 weeks of treatment without relapse for 1 year.…”

Treatment of erythrodermic psoriasis with apremilast

“…To the Editor: Apremilast is a phosphodiesterase 4 inhibitor that blocks proinflammatory effects and promotes anti-inflammatory effects of immunologic cells. 1 We were pleased to read about the success of Jeon et al 2 in using it for treating patients with multiple comorbidities for generalized pustular psoriasis. Similarly, we found meaningful results when patients with numerous comorbidities were treated with apremilast for erythrodermic psoriasis (EP), and we believe that many would find our cases worth reviewing.…”

“…Historically, cyclosporine has been the first-line therapy, with methotrexate and acitretin as close seconds only because of their slower onset of action. 1 , 3 More recently, biologics such as infliximab and ustekinumab have been at the forefront of treatment for EP. 3 Although not currently recognized as a first-line agent, we found that the oral agent apremilast offers promise in the treatment of EP as well.…”

“…To our knowledge, 3 case reports have been published, in which apremilast monotherapy was used for the treatment of EP. 1 , 2 , 4 , 5 Apremilast is well tolerated and offers a mild side-effect profile compared with biologics and immunosuppressants. 1 In summary, we believe that apremilast shows promise for patients with multiple comorbidities and is unreliable in terms of follow-up for drug monitoring.…”