Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : EC01 - EC05 Full Version

Effect of Oral Drug Apremilast on Histopathological Changes in Patients of Plaque Psoriasis: A Prospective Observational Study

Published: March 1, 2023 | DOI:
Yogendra Singh, Ashish Bagaria, Bhawna Bagaria, Yogesh Gupta

1. Resident, Department of Pathology, Rajasthan University of Health Sciences (RUHS), Jaipur, Rajasthan, India. 2. Associate Professor, Department of Pathology, Sawai Man Singh Medical College (SMSMC), Jaipur, Rajasthan, India. 3. Assistant Professor, Department of Biochemistry, Sawai Man Singh Medical College (SMSMC), Jaipur, Rajasthan, India. 4. Associate Professor, Department of Pathology, Rajasthan University of Health Sciences (RUHS), Jaipur, Rajasthan, India.

Correspondence Address :
Yogesh Gupta,
Associate Professor, Department of Pathology, Rajasthan University of Health Sciences (RUHS), Jaipur, Rajasthan, India.


Introduction: Psoriasis is a chronic non infectious recurrent papulosquamous inflammatory disorder characterised by vascular alterations such as angiogenesis, dilatation, increased endothelial venule generation, epidermal keratinocyte hyperproliferation, and aberrant differentiation, and lymphocytic invasion of T-cells. The aetiopathogenesis of disease is influenced by both hereditary and environmental factors. Pathogenesis is significantly influenced by immune dysregulation, which affects both innate and acquired immunity. A relatively recent medication for the management of moderate to severe plaque psoriasis is apremilast, an oral phosphodiesterase-4 inhibitor. Compared to other immune-suppressing drugs used in psoriasis apremilast causes no reactivation of tuberculosis or opportunistic infections, does not need dose adjustment in elderly or patients with hepatic impairment, and is not contraindicated in diabetes, ischaemic heart disease, or congestive cardiac failure. Due to its advantage of the absence of the need for laboratory monitoring, the patients on long-term methotrexate can also be switched to apremilast.

Aim: To evaluate the histopathological changes in the skin of all plaque psoriatic patients treated with oral drug apremilast.

Materials and Methods: This hospital-based prospective study was done in the Department of Pathology at the Rajasthan University of Health Sciences (RUHS), Jaipur, India for a period of one year from February 2020 to January 2021 comparing the efficacy of Apremilast clinically by evaluating plaque psoriasis patients’ by Psoriasis Area and Severity Index (PASI) scores. Patients of all age groups with a clinical diagnosis of psoriasis were subjected to a punch biopsy from an active lesion by a dermatologist. For histopathological examination, biopsy was taken from the lesion before starting treatment with apremilast and after four weeks of apremilast therapy. The subsequent changes in the form of histopathological score and PASI score were analysed and compared with the previous score to study the effect of oral drug apremilast.

Results: Total of 100 patients enrolled in the study with the mean age 39.14 years including 59% males and 41% females. Main site of lesion was back, hand and leg. The PASI score at the first visit was 11.28 and at the second visit were 7.27 with the improvement 35.54% which was statistically significant from first visit (p-value<0.001). The histopathological score at the first visit was 15.98 and at the second visit were 10.06 with the improvement 37.1%.

Conclusion: Apremilast was found to be a safe and effective treatment for psoriasis patients, and this impact was unaffected by confounding variables.


Angiogenesis, Epidermal keratinocytes, Papulosquamous inflammatory disorder, Psoriasis area and severity index score

People of all ages are affected by the widespread chronic systemic inflammatory skin disease known as psoriasis worldwide. Psoriasis prevalence rates range widely depending on geography, from 0.09% to 11.4%, and are predicted to be 2-4% in the Western population (1),(2). While the exact cause of the condition is unknown, psoriasis is widely recognised as a significant disorder brought on by the interaction of inherited susceptibility alleles and environmental risk factors known as triggers (such as trauma, viral and bacterial infections, smoking, weight gain, stress as well as alcohol consumption) (3). Plaque psoriasis is indeed a prevalent type and is distinguished by inflammatory plaques on the skin. Such papulosquamous lesions, which are frequently itchy and/or painful, can develop on both common skin sites like the knees, elbows, scalp, and lumbar region as well as in challenging skin regions like the scalp, nails, palms, and soles of the feet (4). The overproduction of inflammatory cytokines, which alters the immune response, is one of the disease’s key molecular hallmarks. Particularly important are the interleukin IL-12 and IL-23 secreted by myeloid dendritic cells, which stimulate T-helper cells to create IL-17, tumour necrosis factor, interferon, and IL-22. This mechanism causes the keratinocytes to develop prematurely, leukocytes to infiltrate the dermis, and blood vessels to enlarge, which causes the epidermal layer to hyperproliferate and ultimately form plaques (5). There are many ways to treat psoriatic disease symptoms for patients with mild disease, topical and/ or phototherapies may be used, moreover patients with moderate-to-severe ailment traditional systemic treatment which consist of disease modifying antirheumatic drugs, such as (cyclosporine, fumaric acid esters, methotrexate, retinoids) or modern biologic systemic treatments such as (Ixekizumab, infliximab, ustekinumab, secukinumab, adalimumab) can be used (6). Long-term treatment is usually necessary due to the chronic nature of psoriatic illness (7). Dissatisfaction among patients with the available recent therapies often leads to decreased adherence to treatment and as a result, worsening of the illness (8). This may be the result of declining health status brought on by tolerability challenges, safety issues (such as worries about infection or cancer from biological agents), lack of effectiveness, or loss of efficacy, as well as psychological factors like the mode of administration (difficulties brought on by intravenous or subcutaneous methods of administration) (9).

The US Food and Drug Administration on September 24, 2014, approved the oral phosphodiesterase-4 inhibitor apremilast for the management of psoriasis. In comparison to biologics and other systemic antipsoriatic medications, it has the benefit of not requiring laboratory monitoring throughout usage and of being administered via the oral route. The medication controls phosphodiesterase-4, which is abundantly expressed in dendritic cells, monocytes, neutrophils, and keratinocytes and prevents the breakdown of cyclic adenosine monophosphate, to control the immune reactions related to psoriasis. Diarrhoea, nasopharyngitis, nausea, upper respiratory infections, and headache are the most commonly mentioned side-effects (10). Hence, the novelty of this study is that it is conducted to evaluate the clinical efficacy and side-effects of oral apremilast therapy in patients affected by plaque psoriasis.

Material and Methods

This hospital-based prospective study was done in the Department of Pathology at the RUHS Medical College, Jaipur for a period of 1 year from February 2020 to January 2021 after receiving approval from the RUHS-Content Management System (CMS) Ethics Committee (IEC no.-EC/P-28/2019). Consent was obtained either from the patient or their guardians, after explaining the procedure in vernacular language.

Inclusion criteria: Patients with age >18 years and both gender coming to Outpatient Department (OPD) of Dermatology in Rukmani Devi Beni Parsad Jaipuria Hospital, attached with RUHS-CMS Jaipur, who presented with skin psoriasis and confirmed for psoriasis on histopathological examination.

Exclusion criteria:

1. Patients who were non co-operative and did not give consent for punch biopsy.
2. Inadequate biopsy samples were defined as those <4 mm in maximum diameter or showing only the epidermis or dermis on histopathological examination.
3. Patients diagnosed clinically with any other type of psoriasis other than psoriasis vulgaris.
4. Pregnant women.

Sample size calculation: All those patients who fulfilled the inclusion and exclusion criteria were the subjects of the proposed study. The average skin punch biopsy specimens referred to the Histopathology Laboratory, Department of Pathology, RUHS Medical College and Jaipuria Hospital were 50 in the previous six months (as per previous records). A study data of one year was collected, therefore, the total number of patients were 100.

Procedure: Patients of all age groups who had a clinical diagnosis of psoriasis were subjected to a punch biopsy from an active lesion by a dermatologist. Punch biopsy of skin was collected from the lesion’s margin, placed in a vial with fixative (10% formalin), and sent to the Department of Pathology for tissue processing and histopathological examination. After histopathological confirmation of plaque psoriasis, the patient received treatment with apremilast 30 mg dose once a day for the first 14 days followed by 30 mg dose twice a day for the next 14 days. After the completion of an oral dose of 4 weeks of apremilast, a punch biopsy was repeated from the same lesion. The subsequent variations in the form of the histopathological score and PASI score were examined and compared with the previous score to study the effect of the oral drug apremilast (11).

Score for the PASI: 0.1 (EH+IH+SH)AH+0.2 (EU+IU+SU)AU+0.3 (ET+IT+ST)AT+0.4 (EL+IL+S)AL

where, A=Area U=Upper Arm L=legs H=Head T=Trunk
E=Erythema I=Induration S=Scalling

Histopathological processing of punch biopsy of skin: Specimens were fixed in 10% formalin and subsequently processed as per standard technique following that standard methods were used to cut and stain the paraffin sections with Haematoxylin and Eosin (H&E) (Nuclei-blue, Cytoplasm-pink).

Reagents used in Haematoxylin and Eosin staining: Mayer’s hematoxylin was used which was reddish brown in color. 1% stock alcoholic eosin from which working eosin solution was prepared as: just before use, 0.5 mL of glacial acetic acid was added to every 100 mL of stain and blended in with the eosin stock solution as one part to three parts alcohol. (Table/Fig 1) shows 10 histopathological features graded according to their prominence. The Psoriasis Histopathologic Score (PHS) is the total of 10 grading scores for each sample. The histopathological score ranges from 0-40. (Table/Fig 2) shows the PASI score which ranges from 0-72 (11).

Statistical Analysis

On a pre-designed and pre-tested performa, all the information was compiled. The Microsoft Excel sheet 2010 was used to enter the collected data in the form of a master chart. The data was classified and analysed to evaluate the clinical efficacy and side-effects of oral apremilast therapy. Inferences were drawn with the aid of p-value a true test of statistical significance. A p-value <0.05 was considered to be significant.


This study was done for comparing the efficacy of the drug apremilast clinically by evaluating the PASI score. Total of 100 patients enrolled in the study altogether where 59% was female and 41% male with the mean age 39.14 years. Site of lesion was back, hand and leg. (Table/Fig 3) shows the PASI score at the first visit was 11.28 and at the second visit were 7.27, which showed statistically significant results. (Table/Fig 4) shows the histopathological score at the first visit was 15.98 and at the second visit were 10.06, which showed statistically significant results. (Table/Fig 5) shows Psoriasis vulgaris present on scalp showing white silvery scales involving the hair. (Table/Fig 6) shows Psoriasis vulgaris present on abdomen showing silvery white scales, marked erythema and marked induration. (Table/Fig 7) shows Psoriasis Vulgaris present on back showing silvery white scales with crust, erythema and marked induration before treatment. (Table/Fig 8),(Table/Fig 9),(Table/Fig 10) shows skin biopsy performed prior to using apremilast. Psoriasis vulgaris (H&E stain 10x) was seen to have perivascular and dermal lymphocytic infiltration, significant hyperkeratosis, parakeratosis, Munro’s microabscesses, lack of granular layer with acanthosis, thinning of suprapapillary plate, regular clubbing and elongation of the rete ridges, oedema of the dermal papillae, and dilated blood vessels near the dermal papillae’s tip. (Table/Fig 11),(Table/Fig 12),(Table/Fig 13) shows skin biopsy after treatment with apremilast. Psoriasis vulgaris (H&E stain 10x) showed mild hyperkeratosis, mild parakeratosis, Munro’s microabscesses, irregular to regular elongation of rete ridges and clubbing, perivascular and dermal lymphocytic infiltration.


Food and Drug Administration has approved apremilast as a monotherapy for the treatment of moderate to severely persistent plaque psoriasis in the year 2014 (12). Non Steroidal Anti-Inflammatory medicines (NSAIDs) and corticosteroids have been used extensively for treating inflammatory diseases for many years, but long-term use of these medications can result in serious organ damage and a number of additional side effects (13). There are other compounds, such as apremilast, a phosphodiesterase-4 inhibitor that functions intracellularly, and can regulate immunological dysfunction in addition to biologicals, which do so by suppressing extracellular inflammatory chemicals (extracellular pathways) (14). Inhibition of the phosphodiesterase-4 inhibitor leads to an increase in the intracellular second messenger cyclic adenosine monophosphate, the activation of the protein kinase A downstream, and the consequent phosphorylation of the transcription factor response element binding protein. When this route is activated, many cytokines have their gene transcription altered, and tumour necrosis factor α and other proinflammatory cytokines are regulated. Along with interfering with the phenotypic and functionality of B cells, phosphodiesterase-4 inhibitor suppression boosts macrophage production of anti-inflammatory cytokines. By preventing the production of inflammatory mediators, it also promotes keratinocytes and epithelial cells to act as barriers (15). Because of its significant anti-inflammatory properties, the phosphodiesterase-4 inhibitor apremilast has been looked into for the treatment of many rheumatic diseases, including psoriasis and psoriatic arthritis. Considering its multifactorial nature, psoriasis is a chronic skin inflammation disease that can manifest in a variety of ways. According to various studies, one third of patients have inflammatory spondyloarthropathy psoriatic arthritis in addition to psoriasis, while other patients may have a number of metabolic diseases such as diabetes, obesity, fatty liver disease, cardiovascular diseases and metabolic syndrome (16),(17). Patients have a poorer health-related life quality due to the complexity of the potential manifestations, which causes physical and mental disability (18). Clinical trials provide the majority of the evidence for apremilast’s effectiveness and safety in the treatment of psoriasis and psoriatic arthritis (19). Because clinical trial patient populations are preselected, actual treatment outcomes may vary from those seen in clinical trials.

In this hospital-based prospective study, the therapeutic effectiveness of apremilast is compared by measuring the PASI score. The score on the PASI improved by 35.54%. The histopathological score showed improvement at a 37.1% rate. In a research conducted by Papp K et al., a greater percentage of patients- 33.1% vs. 17.7% attained a PASI score75 following roughly 16 weeks of treatment with apremilast (20). The pathophysiological processes connecting psoriasis to the elevated levels of systemic inflammation brought on by adipose tissue, particularly visceral adipose tissue, which functions as an endocrine organ and secretes adipokines. Obesity causes an imbalance of pro- and anti-inflammatory adipokines, which leads to the formation of a persistent low grade inflammatory state that may cause or exacerbate psoriasis (21). Kavanaugh A et al., reported the overall long-term results in individuals with active psoriatic arthritis who used apremilast for up to 260 weeks (22). According to research, people with psoriatic arthritis who used apremilast continued to see therapeutic benefit and a good safety profile for upto 5 years. It is also used as a substitute for various drugs such as methotrexate, cyclosporine, and biologicals which have side-effects like increased risk of infections, liver damage, etc., that necessitate regular monitoring. Voorhees ASV et al., determined that inflammation is an evolutionary conservative mechanism that defends the host from viruses, bacteria, poisons, and diseases through stimulation of immune and non immune cells by eradicating pathogens and fostering tissue healing and repair (23). They observed the effectiveness and safety of apremilast in treating moderate to severe scalp psoriasis. Apremilast significantly increased the number of patients who responded to the scalp physician global assessment (43.3% vs 13.7%), scalp itch numeric rating scales (47.1% vs 21.1%), and whole body itch numeric rating scales (45.5% vs 22.5%) as well as the dermatology life quality index (-6.7 vs -3.8; all p-value < 0.001) when compared to placebo. Treatment of moderate to severe scalp psoriasis with apremilast has been found to be successful. Graier T et al., also found numerous ailments, including cancer, infections, immune-mediated illnesses, and metabolic and neurological diseases, are thought to be primarily brought on by inflammation (24). They examined as to how patient and illness factors affected survival related to the apremilast medication and clinical effectiveness with relation to the reduction of the PASI score. At 12 months, patients receiving apremilast had response rates per protocol with scores of 50, 75, 90, and 100 on the PASI translate to 80.0%, 56.4%, 38.2%, and 22.7%, respectively. With the exception of age, it was found that apremilast was a potent antipsoriatic medicine whose survival is not significantly influenced by the bulk of patient- or disease-related characteristics. Patients under the age of 40 had considerably shorter drug survival. With the exception of brief gastrointestinal discomfort and headache during the first few weeks, authors have reported a satisfactory safety profile for apremilast. Antacid and antiemetics can be started in advance during dose escalation to help patients experience less nausea and vomiting and to help them tolerate their medications better. With the improvement of lesions at particular body areas like the scalp, palms, and soles, apremilast has a modest level of effectiveness in treating chronic plaque psoriasis. Patients with psoriasis and palmoplantar eczemas may benefit therapeutically from it as well. Although few literature suggests that apremilast is helpful for treating nail psoriasis, this hypothesis still needs to be supported by larger research (25),(26).


1. Possible recall bias in reporting adverse effects of the patient.
2. Long-term follow-up of the patients is required.


Apremilast, is a safe and effective medication for people with psoriasis, which shows better improvement in PASI score as well as histopathological score. It is also a safe alternative for patients with immunological suppression, such as those with HIV. Apremilast reportedly improves the symptoms of ulcerative colitis and is supposed to lessen colon inflammation. When combined with a systemic medication like methotrexate or cyclosporine, it can be used as a maintenance or bridge therapy for people who frequently experience flare-ups. When used strategically as an adjunctive or rotational therapy beside biologics and traditional systemic treatments for psoriasis in low resource settings, this relatively effective chemical with a limited need for laboratory testing can reduce treatment costs, side effects, and improve outcomes.


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DOI and Others

DOI: 10.7860/JCDR/2023/60263.17537

Date of Submission: Sep 16, 2022
Date of Peer Review: Nov 03, 2022
Date of Acceptance: Jan 10, 2023
Date of Publishing: Mar 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Sep 23, 2022
• Manual Googling: Dec 30, 2022
• iThenticate Software: Jan 06, 2023 (9%)

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