Apremilast is phosphodiesterase 4 (PDE4) inhibitor that reduces pro-inflammatory cytokine production.
The brand name is Otezla® and is FDA approved for moderate to severe plaque psoriasis and psoriatic arthritis.
Due to its mechanisms for immune modulation and suppression and it relatively good safety profile, it has also been tested in various types of inflammatory alopecia.
Alopecia Areata (AA)
Alopecia areata is an non scarring autoimmune condition hair loss condition. Although the exact cause of AA has not been identified, various immune system abnormalities have been identified including (1):
increased PDE4 in human scalp lesions of AA patients
hair regrowth in a humanized AA mouse model after treated with apremilast.
It is typically treated with various topical and oral anti-inflammatory medications. There have been three recently published studies, including one randomized placebo-controlled single-center investigation, on the use of apremilast in AA (2, 3, 4). Two of the three studies (2, 4) demonstrated no clinical benefit in moderate to severe cases of AA.
Central centrifugal cicatricial alopecia is a lymphocyte-mediated scarring hair loss condition. The exact cause is unknown although several immune pathways have been hypothesized. Since apremilast reduces several inflammatory factors, it is currently being investigated to decrease scalp inflammation in CCCA.
Frontal fibrosing alopecia is a lymphocyte-mediated scarring hair loss condition. The exact cause is unknown although several immune pathways have been hypothesized. Current therapies for the treatment of this FFA have been less than satisfying. Since apremilast reduces several inflammatory pathways, it is currently being investigated to reduce scalp inflammation in FFA.