INTRODUCTION: A significant portion of patients with psoriasis have scalp and 
nail involvement. It has been reported that 40% to 45% of patients with 
psoriasis have nail psoriasis, and up to 80% have scalp involvement. Nail and 
scalp psoriasis have often been found to be difficult to treat, due to the poor 
penetration and poor compliance of topical medication. Oral and biologic 
therapies have shown significant efficacy but often with undesirable side 
effects. Herein, we analyze the efficacy of apremilast, an oral 
phosphodiesterase-4 (PDE-4) inhibitor, in the treatment of nail and scalp 
psoriasis at 16-, 32-, and 52 weeks.
METHODS: We reviewed the results of the phase IIb and phase III clinical trials 
for apremilast in treating nail and scalp psoriasis.
RESULTS: In ESTEEM 1, patients on apremilast showed a 22.5%, 43.6%, and 60.2% 
improvement in NAPSI at weeks 16, 32, and 52. 33.3%, 45.2%, and 63% of patients 
achieved NAPSI-50, respectively. In ESTEEM 2, patients on apremilast showed a 
29%, 60%, and 59.7% improvement in NAPSI at weeks 16, 32, and 52, with 44.6%, 
55.4%, and 68.6% of patients achieving NAPSI-50. In PSOR-005 at week 16, 
patients on a dose of 30 mg twice weekly had a 42.9% improvement in NAPSI with 
45.5% reaching NAPSI-50. For scalp psoriasis, 46.5%, 37.4%, and 73% of patients 
achieved an Sc-PGA of 0 or 1 at weeks 16, 32, and 52 in ESTEEM 1. In ESTEEM 2, 
40.9%, 32.4%, and 62.5% of patients achieved an Sc-PGA of 0 or 1 at weeks 16, 
32, and 52.
CONCLUSION: With its limited safety profile of only diarrhea and headache and no 
additional lab requirements, apremilast may be a safer and more convenient 
alternative for patients with severe nail and scalp psoriasis.