• Apremilast is a promising new small molecule and a valuable addition to the therapeutic armamentarium in psoriasis.
• It can be used as both monotherapy and combination therapy and when patient is intolerant to other systemic therapies or has less response to other therapies.
• As combination therapy it can be used with all agents-methotrexate, cyclosporine, acitretin, phototherapy and biologicals.
• Apremilast gives good response in difficult to treat psoriasis like palmoplantar, nail and scalp psoriasis.
• Apremilast can achieve PASI 75 in 35-40% of patients at Week 16.
• Adverse events (AEs) can occur in nearly 50% of patients. But discontinuation due to AE occurs in only 10-15% of patients.
• Absence of systemic side effects and no lab monitoring required is a major advantage of apremilast.
• Apremilast is the second most affordable agent after methotrexate.

Practice sutra: Proper selection of patients, counseling and experience with continued usage will go a long way in successful use of apremilast.