Efficacy of Apremilast in Refractory Genital Psoriasis: A Retrospective Case Series

ABSTRACT Background Genital pustular psoriasis is a rare and often underdiagnosed condition that can severely affect physical comfort, quality of life and psychological well‐being. It can be particularly challenging to manage, often requiring systemic therapies due to its potential unresponsiveness to conventional topical treatment. Objectives To evaluate the effectiveness of apremilast in treating male patients with refractory genital psoriasis with pustular features, a rare subtype that can be mistaken for other conditions, including infections and Reiter's syndrome. Methods A retrospective case series of six male patients, aged 21−47 years, presenting with recurrent circinate balanitis or balanoposthitis and histological features suggestive of pustular psoriasis (intraepidermal neutrophilic aggregates without frank pustules). These patients had previously failed multiple treatments, including topical corticosteroids, calcineurin inhibitors, acitretin, ciclosporin and methotrexate. Apremilast was initiated with a 6‐day titration protocol, and patients were followed for 1–3 months. Results All six patients showed complete remission within 1−3 months of starting apremilast, with no major side effects reported. Diagnostic work‐up, including viral, bacterial, mycological swabs and syphilis serology, was negative for all patients, and no extragenital symptoms typically associated with Reiter's syndrome were observed. Conclusions Apremilast appears to be an effective and well‐tolerated treatment for refractory genital psoriasis with pustular features, providing a promising therapeutic option for patients with this challenging condition. Further studies with larger cohorts and randomized trials are needed to confirm its long‐term efficacy and safety.