Can Apremilast (apremilast) cure tinea infections?

Apremilast Does Not Cure Tinea Infections

Apremilast is not indicated or effective for treating tinea infections and should not be used for this purpose. 1 Apremilast is specifically FDA-approved for psoriasis, psoriatic arthritis, and oral ulcers of Behçet's disease, with no evidence supporting its use in fungal infections 2.

Approved Indications for Apremilast

Apremilast is a phosphodiesterase-4 inhibitor with specific approved uses:

• Moderate to severe plaque psoriasis in adults 1
• Psoriatic arthritis 1
• Oral ulcers associated with Behçet's disease 2

Mechanism of Action vs. Tinea Pathophysiology

Apremilast works by:

• Inhibiting phosphodiesterase-4 enzyme
• Modulating immune system by increasing intracellular cyclic adenosine monophosphate (cAMP)
• Inhibiting inflammatory cytokines including IL-2, IL-8, interferon-γ and tumor necrosis factor (TNF) 2

This mechanism targets inflammatory pathways in autoimmune conditions but has no antifungal properties needed to treat tinea infections, which are caused by dermatophyte fungi.

Appropriate Tinea Treatments

Tinea infections (including tinea versicolor) require antifungal medications:

• Topical antifungals are first-line for limited disease
• Oral antifungal agents may be needed for extensive disease or treatment failures 3

Risks of Inappropriate Apremilast Use for Tinea

Using apremilast for tinea infections would:

• Provide no benefit for the fungal infection
• Expose patients to unnecessary side effects including:
  • Diarrhea (potentially severe and chronic) 4
  • Nausea
  • Headache
  • Upper respiratory tract infections 5
  • Risk of depression 1
  • Weight loss (>5% of baseline in some patients) 1
• Delay appropriate antifungal treatment, potentially allowing the infection to worsen

Off-Label Uses of Apremilast

While apremilast has been studied for several off-label dermatologic conditions, tinea infections are not among them. Off-label studies have focused on:

• Behçet's disease
• Hidradenitis suppurativa
• Nail/scalp/palmoplantar psoriasis
• Alopecia areata
• Atopic dermatitis 6

Clinical Decision-Making Algorithm

For patients with suspected tinea infection:

1. Confirm diagnosis (KOH preparation, fungal culture, or Wood's lamp examination)
2. For confirmed tinea:
   • Use appropriate antifungal therapy (topical or oral)
   • Do NOT use apremilast
3. If psoriasis is suspected instead of tinea:
   • Biopsy may be needed to differentiate
   • Only consider apremilast if psoriasis is confirmed and meets severity criteria

Key Takeaway

Apremilast has no role in the treatment of tinea infections. Using it for this purpose would subject patients to unnecessary risks without addressing the underlying fungal infection. Proper diagnosis and appropriate antifungal therapy are essential for effective treatment of tinea.