REVIEW article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1633426
Apremilast Treatment of Immune-mediated Inflammatory Skin Diseases: A Narrative Review
Provisionally accepted
- 1Dermatology Hospital, Southern Medical University, Guangzhou, China
- 2Zhongshan Second People's Hospital, Guangdong, China
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Novel therapeutic approaches on molecular pathways are developing in treating inflammatory and autoimmune cutaneous dermatoses. Apremilast is an orally administrated small-molecule phosphodiesterase (PDE) 4 inhibitor that upregulates levels of intracellular cyclic 3',5'-adenosine monophosphate (cAMP), which mediates a large array of pro-inflammatory cytokines and exert its anti-inflammatory function and therapeutic efficacy in skin diseases, rather than an immunosuppressive mode of action. Early-phase clinical trials have demonstrated its favorable efficacy that has led to United States Food and Drug Administration (FDA) approval of psoriasis, psoriatic arthritis and Behç et's syndrome. Compared with conventional immunosuppressive therapies, apremilast has a better safety and tolerability profile, significantly reducing the risk of serious adverse reactions from long-term usage. Even for special areas such as nails, scalp or palms and soles of feet, as well as genitals, apremilast manifests an easier and faster absorption, with clinically meaningful improvements observed. More recently, accumulating real-world evidence has revealed it also serves as a highly effective medication in multiple immune-mediated inflammatory skin diseases in an off-label manner, and seems useful in some chronic inflammatory skin disorders recalcitrant to conventional therapies, either alone or as an add-on treatment. Further large-scale studies and real-life trials are highly required to better elucidate its role in dermatology. This narrative review provides an overview of apremilast offering a novel therapeutic option in skin disorders, including a comprehensive synthesis about its pharmacology, clinical efficacy and safety profile, with the aim of enlightening clinicians about the broad application and full potential of this small-molecular drug regarding currently available evidence.
Keywords: Apremilast, PDE4 inhibitors, immune-mediated inflammatory skin diseases, Cytokines, Small-molecular drug
Received: 22 May 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 Liang, Zheng, Huang, Tan and Liao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia Liao, Zhongshan Second People's Hospital, Guangdong, China
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