Successful Use of Apremilast in Psoriasiform Dermatitis Refractory to Biologics

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.