Apremilast as a novel therapeutic option for psoriasis coexisting primary sclerosing cholangitis and ulcerative...

Plaque psoriasis, primary sclerosing cholangitis, and ulcerative colitis are all immune-mediated inflammatory diseases. Their coexistence is extremely rare, and therapeutic management remains challenging due to shared immunopathogenic mechanisms and limited treatment experience.

A 36-year-old woman presented with pruritic red papules and plaques covering scales all over the body for more than 10 years. She also reported liver dysfunction for over 3 years and chronic diarrhea exceeding 1 year.

Based on her medical history, clinical manifestations, histopathological findings, and examinations, she was diagnosed with plaque psoriasis, primary sclerosing cholangitis, and ulcerative colitis.

The patient had shown an inadequate response to oral steroids and adalimumab. Upon presentation to our clinic, she was assessed as having moderate plaque psoriasis (Psoriasis Area and Severity Index: 6.0, body surface area: 10.0%) and was treated with oral apremilast (titrated up to 60 mg/d), ursodeoxycholic acid (1000 mg/d), and phosphatidylcholine (1368 mg/d).

After 48 weeks of treatment, the patient achieved complete clearance of psoriatic lesions, marked reduction of pruritus, stable liver function, decreased diarrhea frequency, and no adverse events.

This case underscores the potential response and tolerability of apremilast as an alternative treatment for psoriasis coexisting with autoimmune liver disease and inflammatory bowel disease.