BACKGROUND: Difficult-to-treat palmoplantar psoriasis has a disproportionately 
negative impact on quality of life.
OBJECTIVE: We evaluated the efficacy and safety of apremilast in palmoplantar 
psoriasis.
METHODS: A post hoc analysis of data pooled from phase IIb (PSOR-005) and phase 
III (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis 
[ESTEEM] 1 and 2) clinical studies was conducted to determine the effect of 
apremilast 30 mg twice daily versus placebo at week 16 in a subset of patients 
with moderate to severe plaque psoriasis with active palmoplantar psoriasis 
(baseline Palmoplantar Psoriasis Physician Global Assessment [PPPGA] score ≥1).
RESULTS: Significantly more patients taking apremilast with moderate to severe 
palmoplantar psoriasis (baseline PPPGA score ≥3) achieved PPPGA score 0 (clear) 
or 1 (almost clear) compared with placebo at week 16 (48% vs 27%; P = .021). At 
week 16, 46% of the apremilast group with baseline PPPGA score 1 or higher 
achieved a PPPGA score of 0 versus 25% of the placebo group (P < .001); 59% of 
the apremilast group had a PPPGA score of 0 or 1 with 1-point or more 
improvement versus 39% receiving placebo (P < .001).
LIMITATIONS: This post hoc analysis was limited to 16 weeks and did not assess 
palmoplantar pustules, lesion localization, or surface area involvement.
CONCLUSION: Apremilast may be a useful oral treatment option for patients with 
moderate to severe palmoplantar plaque psoriasis.