Transient phototoxic skin reaction in psoriatic patient treated with selective phosphodiesterase 4 inhibitor without discontinuing the use of systemic drugs

Abstract

Background: Apremilast is the first selective inhibitor of phosphodiesterase 4 indicated for adults with active psoriatic arthritis and/or moderate to severe plaque psoriasis. In a preclinical study conducted with mouse fibroblasts exposed to Apremilast and ultraviolet radiation phototoxic effects were not found. In a pooled analysis of four (PALACE 1-4) Phase III studies 1 out of 721 patients receiving Apremilast experienced an adverse event of photosensitivity. The recent 12- week open-label clinical study conducted with 29 patients with moderate to severe psoriasis who received Apremilast and narrowband UVB phototherapy showed one second-degree skin burn (1). We present a rare clinical case of psoriatic patient who developed a transient phototoxic skin reaction while treated with Apremilast and angiotensin receptor II blocker Valsartan, which is reported to cause photosensitivity (2). Methods: Clinical case analysis. Results: 58-year-old male with a 17-year history of moderate and severe psoriasis (PASI score decreased from 13 to 10 after treatment with Methotrexate 10 mg/week for 3 months), arterial hypertension (controlled with Valsartan 160 mg a day), nephrolithiasis and chronic pyelonephritis has been effectively treated with Apremilast (PASI score decreased to 3 after 4 weeks of use). During the treatment patient developed an acute blistering sunburn after few hours of sunbathing next to the Baltic Sea. Previously the patient with skin type III had never experienced severe sunburns. We were able to manage an acute phototoxic skin reaction by applying topical Panthenol and not discontinuing treatment with Apremilast. After healing of acute blistering dermatitis patient achieved full remission of plaque psoriasis (100% reduction in PASI score). In conclusion, treatment with Apremilast is considered safe and effective for moderate and severe psoriasis with only few reports of phototoxicity. Our clinical report shows development of transient acute photot