An In-depth Review of the Off-label Use of Apremilast in Dermatology

Background: Apremilast is a phosphodiesterase-4 (PDE-4) inhibitor approved by the US-Food and Drug Administration (US-FDA) for the management of adult patients with plaque psoriasis (who are candidates for phototherapy/systemic therapy), moderate-to-severely active psoriatic arthritis and Behcet’s disease associated with oral ulcers. Objectives: This review aims to summarize the current evidence for the off-label use of apremilast in various dermatological disorders. Methodology: A comprehensive search of relevant literature was conducted using databases like PubMed, MEDLINE and Embase. Studies investigating the use of apremilast for dermatological conditions beyond its approved indications were included. Results: The use of apremilast has been outlined in a number of reports for inflammatory dermatoses. Randomized controlled trials showed promise for atopic dermatitis, hidradenitis suppurativa and vitiligo. Open-label trials suggested potential benefit in cutaneous sarcoidosis, discoid lupus erythematosus, rosacea and lichen planus. Conclusion: Apremilast can be considered a valid therapeutic option for a range of inflammatory dermatological conditions beyond its approved uses. Further, owing to lack of immunosuppression, apremilast delineates an added advantage when compared to the usual immunosuppressive drugs used by dermatologists. However, stronger evidence from well-designed clinical trials is needed to establish its role in these aforementioned disorders.