A 45-year-old male with both psoriasis and psoriatic arthritis was treated successfully with the combination of apremilast and cyclosporine. This was a very treatment-resistant case in which the patient was not able to tolerate phototherapy, had previously failed etanercept, adalimumab, and ustekinumab, and developed hepatic fibrosis on methotrexate. Apremilast initially allowed a “cyclosporine holiday” to be tolerable. Later, after cyclosporine was restarted, the patient achieved near complete clearance of his psoriasis on the combination of apremilast and cyclosporine for the first time, despite a lower dose of cyclosporine than was previously required over the past few years.
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