Cutaneous reactions to apremilast are rare. This case report describes a patient who experienced purpura annularis telangiectodes of Majocchi (PATM) as an adverse event associated with apremilast, a phosphodiesterase (PDE)-4 inhibitor used in the treatment of psoriasis.
A man in his 60s with a history of psoriasis and psoriatic arthritis developed numerous annular petechial patches after starting apremilast treatment. He had been diagnosed with psoriasis about 7 years earlier and had been treated with efalizumab, adalimumab, etanercept, and ustekinumab. After 4 months of standard dosing with apremilast, he developed telangiectatic patches on his abdomen, arms, and thigh (Figure 1) of 3 weeks’ duration at the time of presentation.