Evolving utility of apremilast in dermatological disorders for off-label indications

Apremilast, a small molecule that acts by inhibition of the phosphodiesterase-4 enzyme, has been approved by the US Food and Drug Administration for the management of psoriatic arthritis, plaque psoriasis and Behçet disease. The drug has drawn much interest from practising dermatologists in view of its exceptional safety profile and prescription convenience, as evident by the recent surge of literature describing its off-label indications. This review was carried out with the aim of summarizing the literature on off-label use of apremilast in dermatology, in order to guide clinicians regarding currently available evidence. The PubMed database was searched using 'apremilast' as a keyword in the title. Abstracts were individually screened to determine whether there was a description of an off-label use of apremilast in dermatology within the article. Randomized controlled trial data were available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.