Apremilast in Psoriasis: Current Landscape and Perspectives

Psoriasis is an immune-mediated skin disease manifested in more than 3% of Americans and over 125 million people worldwide. The inflammatory skin condition with an increased rate of keratinocyte turnover involves every level of the skin and exhibits various forms of the disease, including plaque, guttate, inverse, pustular, and erythrodermic psoriasis, as well as disease-associated conditions, such as psoriatic arthritis and nail psoriasis. Innovative treatment has highlighted the importance of Apremilast, an oral drug that belongs to the phosphodiesterase- 4 (PDE4) class, which was approved by the FDA in 2014. Apremilast works by increasing the presence of cyclic adenosine monophosphate (cAMP) within cells, thereby affecting inflammatory processes and reducing the production of pathological cytokines. Randomized controlled trials have shown that it effectively treats moderately to severely affected plaque psoriasis and psoriatic arthritis, and it is safer than traditional systemic agents. The new perspective on the usage of ethosomes, niosomes, liposomes, and nanostructured lipid carriers in psoriasis treatment is based on emerging nanotechnology in drug delivery systems. These new formulations are designed to enhance the solubility and targeted release of Apremilast, thus providing an enhanced therapeutic effect. This review will discuss the basic mechanisms of the disease known as psoriasis, as well as the mode of operation, pharmacological properties, clinical trials, and pharmacokinetics of apremilast, particularly in relation to nanocarrier modification of this promising drug.