Generalized pustular psoriasis treated with apremilast in a patient with multiple medical comorbidities

G eneralized pustular psoriasis (GPP), von Zumbusch type, is an uncommon variant of psoriasis characterized by acute-onset severe inflammation and widespread sterile pustules within psoriatic plaques. GPP is a medical emergency that often requires hospitalization because of possible life-threatening complications, including heart failure, renal failure, and sepsis. Existing treatment options for GPP are largely limited to systemic immunosuppressive treatments that may be contraindicated in patients with active infection, liver disease, or malignancy. Therefore, management of GPP in patients with $ 1 of these comorbidities is challenging. We report a case of GPP successfully treated with apremilast, a phosphodiesterase-4 (PDE-4) inhibitor approved for the treatment of moderate-to-severe plaque psoriasis, in a patient with hepatitis C, cirrhosis, and hepatocellular carcinoma (HCC).