A Patient With Granuloma Annulare and Lichen Planus Treated With Apremilast: A Case Report

TL;DR

A 55-year-old woman with granuloma annulare and lichen planus showed significant improvement after treatment with apremilast, a drug that reduces inflammatory cytokines.

Contribution

This case report presents apremilast as a potential treatment for granuloma annulare and lichen planus.

Findings

Apremilast led to almost complete resolution of granuloma annulare and lichen planus in a patient.

Apremilast inhibits inflammatory cytokines like TNF-α and IFN-γ, which are implicated in both diseases.

Abstract

Granuloma annulare (GA) is an inflammatory and granulomatous dermatosis characterized by annular erythematous papules/plaques frequently localized in acral regions. Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), which are released by T helper 1 (Th1) lymphocytes inducing macrophages, are thought to play a role in its pathogenesis. Lichen planus (LP) is an inflammatory dermatosis characterized by pruritic scaly purple papules, often on the wrists and ankles, and can also affect mucosa, hair, and nails. T-cell-mediated proinflammatory cytokines such as IFN-γ and TNF-α, which are released by macrophages upon Th1 stimulation, have been implicated in the pathogenesis of LP, as in GA. A new treatment option is needed in the treatment of these diseases due to suboptimal results and adverse side-effect profiles with conventional treatments. Apremilast is a phosphodiesterase-4 (PDE4) inhibitor and inhibits the production of various inflammatory mediators such as IFN-γ, TNF-α, IL-2, IL-5, IL-8, IL-12, and leukotriene B4. This molecule has three Food and Drug Administration (FDA) approved indications: moderate to severe plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet's disease. Apremilast exhibits a favorable side-effect profile compared to conventional treatments and is a good treatment option with its ability to reduce cytokines implicated in the pathogenesis of GA and LP. Here, we report the case of a 55-year-old woman in whom apremilast treatment led to an almost complete resolution of her GA and LP.

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