A Systematic Review of Apremilast as a Therapeutic Option for Lichen Planus

OBJECTIVE: To evaluate the efficacy and safety of apremilast use in various types of lichen planus (LP) and its association with demographics, dosage, and duration. DATA SOURCES: PubMed, EMBASE, and Cochrane CENTRAL were searched for articles that reported apremilast use in any form of LP from inception to July 2024. STUDY SELECTION: Eighteen articles were identified, of which 6 studies (17 patients) met the eligibility criteria. DATA EXTRACTION: Demographic details, type of LP, prior therapies, concomitant therapies, dose and duration used, efficacy and adverse effect profile, and reasons to stop apremilast. DATA SYNTHESIS: Among 17 patients included, 12 (71%) were female, and oral LP was the most common subtype (88%). Forty-one percent of all patients, including 5/15 (33%) oral and 1/1 (100%) oral + cutaneous and 1/1 (100%) esophageal LP patients, achieved remission. Disease progression (29%) was the major reason for treatment discontinuation. No life-threatening adverse effects were reported. Among patients who achieved remission, most were female (7/7) and required treatment for <6 months (6/7); the majority (6/7) did not need concurrent therapy and experienced minimal adverse effects. Relapse and long-term follow-up data were not available. CONCLUSIONS: Apremilast appears to be a promising monotherapy for LP, particularly for oral LP in patients who have not responded to multiple treatments. It is generally well tolerated, with a favorable safety profile. However, heterogeneity in dosing, limited follow-up data, and small sample size necessitate further studies to establish apremilast’s role in LP management.