Erythrodermic psoriasis treated with apremilast

Abstract

Erythroderma is a rare potentially deadly exfoliative dermatitis characterized by diffuse cutaneous erythema which may be associated with multi-organ dysfunction. Therefore, it is imperative to recognize and treat it promptly. Erythrodermic psoriasis is the most common form of erythroderma. Management of this condition is largely based on aggressive supportive care and the use of anti-inflammatory immunosuppressive and biologic agents. We describe a case of psoriatic erythroderma which was triggered by withdrawal from systemic steroids and successfully treated with apremilast and cyclosporine. Apremilast induced atrial fibrillation limited its continued use after the initial response period.

Pediatric Dermatology ‐ critical approach to the new treatments

“…Apremilast could be a potential choose for the nail psoriasis, scalp psoriasis, generalized pustular psoriasis, palmoplantar psoriasis, and erythrodermic psoriasis (Arcilla et al, ; Bissonnette et al, ; Jeon et al, ; Kushwaha, Repka, & Narasimha Murthy, ; Nguyen et al, ). There are only a case reported that apremilast was safe and efficacy for pediatric psoriasis (Smith, ), therefore, more evidence is expected.…”

“…The safety and efficacy of apremilast in psoriasis had been conducted in two multicenter, randomized, double blind, placebo-controlled trials, in which 31.7% apremilast patients achieved PASI75 versus 5.5% placebo patients at 16 weeks (Papp et al, 2015;Paul et al, 2015). Apremilast could be a potential choose for the nail psoriasis, scalp psoriasis, generalized pustular psoriasis, palmoplantar psoriasis, and erythrodermic psoriasis (Arcilla et al, 2016;Bissonnette et al, 2017;Jeon et al, 2017;Kushwaha, Repka, & Narasimha Murthy, 2017;Nguyen et al, 2016). There are only a case reported that apremilast was safe and efficacy for pediatric psoriasis (Smith, 2016), therefore, more evidence is expected.…”

Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy

“…Apremilast has not been studied for the management of stable or unstable EP. There is one case of EP with significant systemic inflammatory response requiring inpatient admission that improved after 10 days of apremilast, but it had to be stopped due to development of atrial fibrillation, and the patient was switched to cyclosporine 4. There is another case of nearly EP flare in a patient with psoriasis for 25 years, due to discontinuation of adalimumab while on treatment for latent tuberculosis (TB), that responded well to apremilast 5.…”

Rapid clearance of erythrodermic psoriasis with apremilast

“…There is only one case report in the literature where apremilast showed fast response in erythrodermic psoriasis but was early discontinued due to cardiologic issues. 4…”