INTRODUCTION: Psoriasis is a chronic inflammatory skin disease characterized by 
dysregulation of the immune system and release of pro-inflammatory mediators. 
Drugs available for psoriasis show some limits as tolerability and route of 
administration. Apremilast , Otezla®, is an oral small molecule recently 
approved for the treatment of patients with moderate-to-severe plaque psoriasis. 
Compared to biologics that target a single cytokine, apremilast, degrading 
phosphodiesterase 4 (PDE4), interferes with cyclic anti-microbial peptides, 
which is involved in the transduction of intracellular signals, controlling the 
balance of pro-inflammatory and anti-inflammatory signals.
AREAS COVERED: This review reported the latest data available from Phase I, II 
and III trials on apremilast for the treatment of plaque psoriasis. A focus on 
the clinical management of apremilast, safety and clinical efficacy based on two 
pivotal clinical trials (ESTEEM 1 and ESTEEM 2) currently ongoing was described. 
A systematic search was conducted using the PubMed Medline database for primary 
articles.
EXPERT OPINION: Apremilast treatment was demonstrated effective and well 
tolerated in Phase II and III clinical trials. Several drug peculiarities, such 
as the low frequency of adverse events and the oral route of administration, 
make apremilast an innovative treatment for moderate-to-severe psoriasis.