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Despite this wide array, oral ulcers are the main symptom.</p><p id="par0010" class="elsevierStylePara elsevierViewall">These lesions are the initial manifestation in up to 80% of patients and usually precede subsequent symptoms by an average of 7–8 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These ulcers are indistinguishable from conventional canker sores of the oral mucosa. They are painful and are characterized by their cyclical presentation, which, as in the case of our patient, can have a significant impact on quality of life. The genital lesions are similar to those of the oral mucosa, although they tend to be smaller, less recurrent and with a greater tendency to scar.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 28-year-old woman, a native of Morocco, with a history of years of intensely painful oral and genital ulcers that occurred in the form of outbreaks, with about 4–5 outbreaks/year.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Since her arrival in Spain, she has been monitored in Rheumatology, meeting criteria for the diagnosis of Behçet disease. She came to the consultancy due to recurrence and worsening of the aforementioned lesions, which interfered with her daily life due to the intense pain.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A physical examination revealed the presence of 3 ulcers on the oral mucosa, as well as a larger one on the left vulva labia minora. The DLQI = 30/30. The lab results were within normality. The HLA B51 study marker was positive.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Topical treatment was prescribed with 0.5% triamcinolone acetonide and 2% lidocaine in Orabase® 3 applications/day, together with oral glucocorticoids at a dose of 0.5 mg/kg/day, with partial response in the control of active lesions. As maintenance treatment, colchicine was used orally at doses of 1 mg/day, azathioprine 100 mg/day and cyclosporine 300 mg/day. All were suspended due to lack of response. We proposed treatment with apremilast 30 mg/12 h, with total disappearance of the ulcers, both oral and genital, after 2 weeks. After a year of follow-up, our patient has not had any further outbreak of ulcers.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Behçet aphthous ulcers, in general, pose a therapeutic challenge. The response to topical treatments is irregular and incomplete. A wide variety of systemic therapeutic modalities have been tried in this regard, although none of them have shown sufficient efficacy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Apremilast, a phosphodiesterase-4 inhibitor, was effective in a phase 2, double-blind, placebo-controlled study. This study showed, in 111 patients after 12 weeks of treatment, a significant decrease in the number of oral ulcers and associated pain in the group treated with apremilast compared to the group treated with placebo. Although the number of patients studied was lower, the decrease in the number of genital ulcers was also significantly greater in the apremilast group. Mild side effects, such as nausea and gastrointestinal upset, were seen more frequently in the group treated with apremilast.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We conclude that, although the literature published to date is scarce, and the aforementioned preliminary study was not large enough or long enough to evaluate long-term efficacy, the development of new immunomodulatory agents such as apremilast shows promise in treatment of oral and genital ulcers in Behçet disease, and can currently be considered a valid alternative for refractory patients.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that there has been no funding or conflict of interest in carrying out this work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Galán Sánchez JL, Eguren Michelena C, de la Cueva Dobao P. Apremilast en el tratamiento de las aftas orales en la enfermedad de Behçet. Med Clin (Barc). 2020;155:513.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Behçet’s disease—case presentation and review literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ferizi" 1 => "A. Gerqari" 2 => "M. Ferizi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3889/oamjms.2018.393" "Revista" => array:6 [ "tituloSerie" => "Open Access Maced J Med Sci" "fecha" => "2018" "volumen" => "6" "paginaInicial" => "1871" "paginaFinal" => "1874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30455765" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Behcet disease: a new therapeutic agent" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.N. Robinson" 1 => "C. 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Hatemi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BOR.0000000000000231" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "2016" "volumen" => "28" "paginaInicial" => "45" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26555450" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000011/v1_202012152105/S2387020620305192/v1_202012152105/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000011/v1_202012152105/S2387020620305192/v1_202012152105/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620305192?idApp=UINPBA00004N" ]
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Vol. 155. Issue 11.
Pages 512-513 (December 2020)
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Vol. 155. Issue 11.
Pages 512-513 (December 2020)
Letter to the Editor
Apremilast for the treatment of oral aphthae in Behçet disease
Apremilast en el tratamiento de las aftas orales en la enfermedad de Behçet
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José Luis Galán Sánchez, Cristina Eguren Michelena, Pablo de la Cueva Dobao
Servicio de Dermatología y Venereología Médico-Quirúrgica, Hospital Universitario Infanta Leonor, Madrid, Spain
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