Successful treatment of refractory folliculitis decalvans with apremilast

Fässler, Mirjam; Radonjic-Hoesli, Susanne; Feldmeyer, Laurence; Imstepf, Valentina; Pelloni, Lorenzo; Yawalkar, Nikhil; Viragh, Pierre A. de

doi:10.1016/j.jdcr.2020.08.019

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…The phenomenon of challenge and rechallenge [35] and flare-ups following medication discontinuation [36] were observed in a few of the cases. Despite a quick response and near-complete improvement in some signs and symptoms (with positive challenge/ rechallenge phenomenon) in one patient, apremilast did not lead to hair regrowth [39].…”

Section: Folliculitis Decalvans (Fd)mentioning

confidence: 82%

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

Hajizadeh,

Heidari,

Sadeghi

et al. 2024

PLoS ONE

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Background Cicatricial alopecia (CA) refers to various conditions that result in permanent hair loss. Treatment of CA has always been challenging. Regarding immune-mediated pathophysiology for many CA subtypes, the administration of Janus kinase (JAK) and tumor necrosis factor (TNF) inhibitors have potentiated the treatments of CA. Methods After a thorough systematic search in PubMed/Medline, Embase, Web of Science, Scopus, Google Scholar, ClinicalTrials.gov, and WHO ICTRP, a total of 3,532 relevant records were retrieved and screened. Accordingly, 56 studies met the eligibility criteria and entered the review. Results Among JAK inhibitors, oral tofacitinib was the most frequently reported and the most effective treatment in improving signs and symptoms of CA with minimal adverse effects (AEs). Baricitinib was another JAK inhibitor with sustained improvement while causing mild AEs. As a TNF inhibitor, adalimumab induced a rapid and stable improvement in signs and symptoms in most patients with rare, tolerable AEs. Thalidomide was the other frequently reported yet controversial TNF inhibitor, which caused a rapid and significant improvement in the condition. However, it may result in mild to severe AEs, particularly neuropathies. Infliximab is a TNF inhibitor with mostly favorable results, albeit in a few patients caused treatable dermatological AEs. Apremilast and certolizumab pegol caused an incomplete amelioration of signs and symptoms with no AEs. Lenalidomide is another TNF inhibitor that can induce temporary improvement in CA with probable AEs. It is noteworthy that utilizing adalimumab, infliximab, etanercept, golimumab, and an anonymous TNF inhibitor has induced paradoxical CA and other A.E.s in some patients. Conclusion Recent studies have recommended JAK and TNF inhibitors, especially oral tofacitinib and adalimumab, as a new modality or adjuvant therapy to previous medications for primary CA. Nonetheless, monitoring AEs on a regular basis is suggested, and further extensive studies are required before definitive recommendations.

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Section: Folliculitis Decalvans (Fd)mentioning

confidence: 82%

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

Hajizadeh,

Heidari,

Sadeghi

et al. 2024

PLoS ONE

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“…A detailed summary of these case series is presented in Table 11. Individual case reports have described successful use of apremilast in pemphigus vulgaris, 61 folliculitis decalvans, 62 chronic actinic dermatitis, 63 Sneddon–Wilkinson disease, 64 chronic hand eczema with hepatogenic pruritus, 65 SAPHO ( s ynovitis, a cne, p ustulosis, h yperostosis and o steitis) syndrome, 66 lamellar ichthyosis, 67 pyoderma gangrenosum, 68 erythema annulare centrifugum 69 and perforating dermatosis 70 …”

Section: Off‐label Dermatological Uses Of Apremilastmentioning

confidence: 99%

Evolving utility of apremilast in dermatological disorders for off-label indications

Mehta

Sharma

Dogra

2022

Clinical and Experimental Dermatology

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Apremilast, a small molecule that acts by inhibition of the phosphodiesterase‐4 enzyme, has been approved by the US Food and Drug Administration for the management of psoriatic arthritis, plaque psoriasis and Behçet disease. The drug has drawn much interest from practising dermatologists in view of its exceptional safety profile and prescription convenience, as evident by the recent surge of literature describing its off‐label indications. This review was carried out with the aim of summarizing the literature on off‐label use of apremilast in dermatology, in order to guide clinicians regarding currently available evidence. The PubMed database was searched using ‘apremilast’ as a keyword in the title. Abstracts were individually screened to determine whether there was a description of an off‐label use of apremilast in dermatology within the article. Randomized controlled trial data were available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.

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“…There was complete resolu on of symptoms a# er 3 weeks of therapy. 43 The therapy was discon nued a# er 7 weeks leading to rapid fl are up of disease. On re-ini a on of Apremilast, there was rapid resolu on of symptoms and the pa ent remained in remission for more than 25 weeks on therapy, with no adverse eff ects.43 Apremilast, with its rapid response and safe drug profi le, can be used in cases of diffi cult to treat folliculi s decalvans.…”

Section: Recurrent Folliculi! S Decalvansmentioning

confidence: 99%

Non-FDA-Approved Uses of Apremilast in Dermatology: A Review of Current Available literature

Bhatia¹

2022

Nepal J Dermatol Venereol & Leprol

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Introduction: Apremilast, an oral phosphodiesterase-4 inhibitor, decreases the production of pro-inflammatory cytokines including tumour necrosis factor-α, interleukin-12/23, IL-12, IL-2, and interferon-γ; while upregulating the anti-inflammatory cytokine IL-10. Its pan-immunomodulatory nature has led to its use in managing various immune-mediated dermatoses for non-FDA-approved indications. Objectives: To review and analyze the use of Apremilast in Non-FDA-approved indications in current available literature. Materials and methods: PubMed, EMBASE, SCOPUS, and Google scholar databases were searched with the parameters “Apremilast”, “Apremilast NOT Psoriasis*”, “Apremilast NOT Behçet’s*”, and “Apremilast NOT arthritis*”. A total of 45 relevant articles were chosen for review. Results: We found 22 indications in dermatology where apremilast has been used without FDA approval. The best evidence was for treatment in Atopic Dermatitis, Alopecia Areata, and Hidradenitis Suppurativa, with randomized controlled trials. Prospective open-label trials were found for Cutaneous Sarcoidosis, Lichen Planus, Rosacea, and Vitiligo. Individual case series and reports were found for Acrodermatitis Continua of Hallopeau, Dermatomyositis, Disseminated Granuloma Annulare, Erythema Nodosum Leprosum, Morphea, Pityriasis Rubra Pilaris, Hailey-Hailey Disease, Recurrent Erythema Multiforme, and Folliculitis Decalvans, Prurigo Nodularis, Perforating Dermatoses, Chronic Actinic Dermatitis, and Hand Eczema, and Epidermolysis Bullosa Simplex-Generalised Severe Type. Apremilast has shown varied efficacy despite a better safety profile and tolerability over a long duration compared to conventional immunosuppressant drugs and placebo. Conclusion: Apremilast has been used for varied non-FDA-approved indications in dermatology with variable efficacy. Better controlled, randomized studies with adequate sample size and drug comparisons are needed for better analyses.

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Successful treatment of refractory folliculitis decalvans with apremilast

Cited by 6 publications

References 6 publications

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

Evolving utility of apremilast in dermatological disorders for off-label indications

Non-FDA-Approved Uses of Apremilast in Dermatology: A Review of Current Available literature

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