Favorable response to apremilast in a patient with refractory psoriasis verrucosa

Abstract

A 67‐year‐old man, who had been diagnosed with psoriasis 30 years prior, visited our hospital with a complaint of verrucous nodules in the lower legs, which had developed 15 years previously. We diagnosed him as having psoriasis verrucosa of the legs and plaque psoriasis of the torso. Because the lesions were resistant to topical glucocorticoids and vitamin D3, a verrucous lesion in the right leg was treated with surgical ablation, which resulted in the development of generalized pustular psoriasis. After pustular lesions were cleared by systemic glucocorticoids and methotrexate, we treated him with etretinate and cyclosporin, but the verrucous lesions accompanied by chronic bacterial infection persisted over time. One year ago, treatment with recently‐approved apremilast was started. It immediately attenuated the plaques and erythropapular lesions of the trunk. Surprisingly, the verrucous nodules of both legs showed reduction in size in 2 months.

Interleukin-17A and Keratinocytes in Psoriasis

“…The topical application of steroids and vitamin D3 analogues inhibits psoriatic inflammation and normalizes epidermal differentiation [38,39]. Systemic treatments, such as methotrexate, cyclosporine, phototherapy, and the phosphodiesterase 4 inhibitor apremilast, are useful for patients with extensive lesions [40][41][42][43][44][45].…”

Beneficial Impact of Apremilast on Palmoplantar Keratodermas

“…We recently demonstrated the striking impact of apremilast on psoriasis verrucosa, characterized by verruca-like papillomatous epidermal hyperplasia and hyperkeratosis, which is refractory to all other treatments ( 5 ). Collectively, apremilast is beneficial for subtypes of psoriasis with marked epidermal hyperplasia and/or hyperkeratosis.…”

Psoriasis verrugosa en un hombre con antecedentes de psoriasis en placa, reporte de caso y revisión de la literatura

“…Con el uso de acitretín, etretinato, metotrexato y de la terapia biológica con etanercept, adalimumab, infliximab y ustekinumab, se ha obtenido una mejoría parcial 1 , 7 . Recientemente, se describió el caso de un paciente con psoriasis verrugosa de larga data que recibió múltiples tratamientos sin éxito; finalmente, presentó mejoría con apremilast 8 .…”