2025 Clinician Corner - Exploring apremilast in the treatment of lichen planus pemphigoides: a new remedy

Abstract 

Lichen planus pemphigoides (LPP) is an uncommon autoimmune dermatosis characterized by a combination of lichenoid lesions and bullous lesions. While its pathogenesis is often considered idiopathic, some cases have been associated with certain medications and infections. The standard treatment for LPP involves systemic corticosteroids. However, the suboptimal recurrence rate of 20% and the presence of various side effects highlight the need for alternative approaches. Recognizing the role of proinflammatory cytokines in the pathogenesis of LPP and targeting their reduction and related pathways has emerged as a promising therapeutic strategy. This case report details the experience of a 67-year-old woman with a history of LPP, showing disease progression despite undergoing multiple conventional therapies. Faced with the inadequacy of traditional treatments, we achieved successful results by using apremilast as an effective intervention.  

Keywords:  Apremilast; blister; bullous; lichen planus; pemphigoides; skin disorder

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on September 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize the clinical presentation of lichen planus pemphigoides, identifying the characteristic pruritic, violaceous, or erythematous lichenoid lesions with scattered bullous lesions, and differentiate it from similar dermatological conditions. 
  • Assess the potential use of apremilast in the treatment of lichen planus pemphigoides, considering its efficacy in corticosteroid-resistant cases and its impact on symptom improvement. 
  • Explain the mechanism of action of apremilast, particularly its inhibition of phosphodiesterase-4 and the resulting reduction in proinflammatory cytokines, as well as its application in treating autoimmune dermatoses like lichen planus pemphigoides. 

Key Points 

  • Lichen planus pemphigoides (LPP) is a rare, autoimmune skin condition that uniquely combines lichenoid lesions with bullous manifestations, posing distinct diagnostic and therapeutic challenges.  
  • Apremilast demonstrated significant efficacy in managing LPP in a patient with a history of inadequate responses to conventional therapies, highlighting its potential as a novel therapeutic strategy that warrants further investigation
  • Apremilast is an oral phosphodiesterase-4 inhibitor that reduces the production of proinflammatory cytokines. This mechanism is particularly relevant for treating LPP, as the condition is characterized by inflammatory processes that can be effectively managed by targeting these mediators. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
09/01/2025
Course expires: 
09/01/2026
Cost:
$25.00
Rating: 
0
  • Hannah Chaudhury, BS - Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA 
  • Nicole Remmert, BS  - Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA 
  • Meredith Pham, MD - Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 
  • Michelle Tarbox, MD - Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 

Corresponding author: Hannah Chaudhury, BSA, 3601 4th Street, Stop 9400, Lubbock, TX 79430-9400 (e-mail: [email protected]) 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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