Successful Treatment of Palmoplantar Pustulosis With Apremilast

Journal of Drugs in Dermatology patient.Disease remission was maintained after 6 months, and the medication was well-tolerated by the patient without any reported side effects. DISCUSSIONApremilast works via PDE-4 inhibition, resulting in an upregulation of intracellular cyclic adenosine monophosphate (cAMP) and subsequent suppression of interleukin-2 (IL-2), interleukin-8 (IL-8), interferon gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α). 2,3Furthermore, increased levels of IL-8 have been demonstrated in lesions of PPP.Given its neutrophil chemoattractant properties, IL-8 is implicated in the underlying development of PPP. 1 The efficacy of apremilast in PPP is therefore presumed to be an effect of IL-8 inhibition, thus preventing formation of the characteristic pustules.PPP refractory to topical treatments may benefit from the introduction of systemic and/or biologic agents.Anecdotal reports of success with etanercept (TNF-α inhibition), ustekinumab (IL-12/23 inhibitions), and secukinumab (IL-17 inhibition) exist, however, evidence is lacking and inconclusive. 4-6 Guselkumab, an IL-23 inhibitor, has demonstrated efficacy in a randomized controlled trial (RCT) and is currently approved for PPP in Japan. 7 Systemic agents including methotrexate, acitretin, and cyclosporine have all shown efficacy, however, the adverse side effects associated with the aforementioned agents makes their use disfavorable. 8Side effects of apremilast, on the other hand, primarily consist of diarrhea and depression, which are typically Successful Treatment of PalmoplantarPustulosis With Apremilast