Successful Use of Apremilast in Psoriasiform Dermatitis Refractory to Biologics

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Christopher Yang
Victor Quan
Ahmad Amin


psoriasis, phosphodiesterase-4, biologics, psoriasiform dermatitis, atopic dermatitis, apremilast, methotrexate, dupilumab, cyclosporine, adalimumab, ustekinumab, guselkumab, ixekizumab


Psoriasis is a common immune-mediated genetic disease that can affect the skin, nails, and joints. Management is usually comprised of topical therapy and/or systemic therapy, either biologic or nonbiologic. This case shows a psoriasiform dermatitis with primary response failure to several systemic biologic and nonbiologic therapies for atopic dermatitis (methotrexate, dupilumab) and psoriasis (cyclosporine, adalimumab, ustekinumab, guselkumab, ixekizumab). Ultimately, the patient was treated successfully with apremilast. This case suggests that certain cases of psoriasis may improve exclusively with PDE-4 inhibition. Conversely, this could also suggest existence of a separate entity of psoriasiform dermatitis that is primarily mediated by PDE-4. We encourage a trial of apremilast in patients presenting with disease mimicking psoriasis who fail multiple therapies.


1. Boehncke WH, Schon MP. Psoriasis. Lancet. 2015;386(9997):983-994.

2. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):1945-1960.

3. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017;63(4):278-285.

4. Talamonti M, Spallone G, Di Stefani A, Costanzo A, Chimenti S. Efalizumab. Expert Opin Drug Saf. 2011;10(2):239-251.

5. Keating GM. Apremilast: A Review in Psoriasis and Psoriatic Arthritis. Drugs. 2017;77(4):459-472.

6. Simpson EL, Imafuku S, Poulin Y, et al. A Phase 2 Randomized Trial of Apremilast in Patients with Atopic Dermatitis. J Invest Dermatol. 2019;139(5):1063-1072.

7. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):1387-1399.

8. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):37-49.

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