Lichenoid dysplasia treated by apremilast - report of two cases and review of literature.

Abstract

Lichenoid dysplasia (LD) is a distinct clinicopathologic condition characterized by bilateral or unilateral oral lesions with a lichenoid pattern and atypical cells, giving it a higher risk for malignant transformation. Unlike oral lichen planus (OLP) or oral lichenoid lesions (OLL), LD lacks basal cell degeneration and shows an immune response to dysplastic cells rather than keratinocytes. This case series presents two female patients with LD, treated with Apremilast, a PDE4 inhibitor. Both patients experienced significant improvement after a 12-week treatment, as assessed by physician global assessment (PGA), subject global assessment (SGA), and target area lesion symptom score (TALSS). Apremilast reduced inflammation and promoted healing, without notable side effects aside from mild gastric irritation. This is the first known use of Apremilast in LD management, showing promising results and reinforcing LD as a distinct, non-tobacco-related entity with a potential immune response link. Further studies are needed to explore its long-term efficacy and transformation risk.