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Do PDE4 Inhibitors Reduce Inflammation in Plaque Psoriasis?

Plaque psoriasis is an inflammatory condition of the skin. The condition causes slightly elevated bumps, along with scaling and inflammation on the skin. The area where this occurs becomes itchy and red. These patches may also become very painful, not to mention patients of psoriasis feel extremely self-conscious due to the unsightly appearance of these plaques. Plaque psoriasis is typically found on the elbows, knees, and scalp, though they can occur anywhere on the body. It is a genetic and a chronic autoimmune condition. There is no cure for plaque psoriasis, but there are treatment options available to keep your symptoms under control.

Do PDE4 Inhibitors Reduce Inflammation in Plaque Psoriasis?

PDE4 inhibitors, a common one being apremilast (brand name Otezia), go inside the body and stop the process of inflammation. If you are suffering from a moderate to severe degree of plaque psoriasis, then PDE4 inhibitors may help you manage your symptoms. However, PDE4 inhibitors are not for everyone and you should discuss with your doctor before taking medications.

Plaque psoriasis, one of the most common forms of psoriasis, often leads to psoriatic arthritis as well. Nearly 35% of patients having plaque psoriasis end up developing psoriatic arthritis, which causes joint pain and also lowers your quality of life. The primary reason why psoriatic arthritis develops is due to the fact that patients fail to control the inflammation associated with plaque psoriasis. If patients control inflammation, it causes the psoriasis outbreaks to become less and less, not just in frequency but also in severity. Controlling the inflammation also prevents or at least stalls the progression to psoriatic arthritis in most patients.

How Does It Happen?

PDE4 inhibitors are a relatively new class of drugs used for suppressing the immune system, thus lowering inflammation. PDE4 inhibitors work at the basic cellular level to stop the production of PDE4, which is an overactive enzyme present in the immune system.

Experts have found that PDEs (phosphodiesterases) cause degradation in the cyclic adenosine monophosphate (cAMP). cAMP is actually responsible for managing the signaling pathways that exist between cells. The level of cAMP increases when PDE4s are stopped.

A study published in the Journal of Clinical and Experimental Dermatology Research in 2016, the increased rate of cAMP has been shown to have anti-inflammatory properties, particularly in people who have atopic dermatitis and plaque psoriasis, or any form of psoriasis for that matter.

PDE4 drugs are actually biologic treatments that act on specific pathways and interrupt the inflammatory response of the body that causes the symptoms of plaque psoriasis. Amongst the PDE4 drugs, adalimumab (brand name Humera), infliximab (brand name Remicade), and etanercept (brand name Enbrel) are injected into the body, while apremilast is taken orally.

What are the Benefits of PDE4 Drugs?

Clinical trials have shown that PDE4 drugs can benefit people suffering from plaque psoriasis. For example, doctors recommend apremilast for patients who are suffering from mild to severe plaque psoriasis and who are also ideal candidates for phototherapy or systemic therapy. In fact, in several clinical trials involving apremilast, it was seen that a majority of people taking apremilast performed better on the Psoriasis Area and Severity Index (PASI) as compared to participants who were put on a placebo.

Are There any Side Effects of PDE4 Drugs?

Like all medications, there are risks and benefits associated with MDE4 inhibitors as well. There is no doubt that PDE4 drugs hold a lot of potential in the treatment of plaque psoriasis. However, these drugs are not for everyone. In fact, apremilast has currently only been approved for adults and has not even been tested on breastfeeding or pregnant women.

There are many known side effects and risks associated with PDE4 drugs. Patients who are taking apremilast may experience the following side effects:

Apremilast also carries the risk of increases depression or feelings of suicide in many patients. This is why doctors suggest that people, who have a history of suicidal behavior or depression, should ideally avoid taking apremilast.

If you experience any side effects while taking PDE4 drugs, you should consult your doctor immediately.


Even though plaque psoriasis is a chronic condition, it can still be managed. People suffering from plaque psoriasis need to understand that inflammation is what causes a flare-up in your symptoms. Therefore, your doctors may recommend that you make use of a PDE4 inhibitor to keep your plaque psoriasis under control. The new medications like PDE4 drugs provide relief to patients with psoriasis, but they are not free from side effects and risks. This is why you need to work together with your doctor, making sure to tell all the information about your health, before beginning any type of the new treatment for managing plaque psoriasis.


  1. Papp, K., Reich, K., Leonardi, C. L., Kircik, L., Chimenti, S., Langley, R. G., … & Paul, C. (2015). Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). Journal of the American Academy of Dermatology, 73(1), 37-49. doi:10.1016/j.jaad.2015.05.042

  2. Sebba, A. (2015). Apremilast: a novel PDE4 inhibitor in the treatment of autoimmune and inflammatory diseases. Therapeutic Advances in Musculoskeletal Disease, 7(5), 232-245. doi:10.1177/1759720X15586457

  3. Mrowietz, U., Szepietowski, J. C., Loewe, R., Van De Kerkhof, P. C., Evers, A. W., & Reich, K. (2017). Drug safety of systemic treatments for psoriasis: results from The German Psoriasis Registry PsoBest. Archives of Dermatological Research, 309(10), 863-872. doi:10.1007/s00403-017-1782-y

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 2, 2023

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