Case reportApremilast is an oral inhibitor of phosphodiesterase‐4 (PDE4) recently approved for the treatment of psoriasis and psoriatic arthritis (PsA).We report the case of a 70‐year‐old female patient affected with severe psoriasis and PsA for more than 30 years, who developed cutaneous skin hyperpigmentation while treated with oral apremilast 30 mg/bid (Fig. ).Patient before (a) and during apremilast treatment (b) exhibiting increase in size and darkening of the solar lentigines resembling intense UV exposureOver decades, she had been variously treated with PUVA, acitretin, cyclosporine‐A, and methotrexate. She was also treated with infliximab first and then adalimumab with optimal response of cutaneous and articular symptoms; however, during both biologics she developed ANA‐positivity with levels up to 1:1280 that were completely reversible after treatment suspension.Eight weeks after adalimumab discontinuation, the patient presented with a psoriasis area and severity index (PASI) score of 5, severe morning stiffness, visual analog scale (VAS) pain 6, important functional limitation with tender, swollen, and painful II, III, IV‐distal interphalangeal (DIP) and metacarpophalangeal (MCP) joints of both hands, and ultrasonographic active tenosynovitis of all the involved articulations. In addition, she developed new PsA symptoms at the right ankle and metatarsal sites of the right foot.The patient had
International Journal of Dermatology – Wiley
Published: Jan 1, 2018
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