This appears to be a mechanism to preserve epithelial integrity.<h4>Objectives</h4>To determine whether apremilast, an inhibitor of the PDE4 normally used in psoriasis, may be of benefit in the blistering skin disorder pemphigus.<h4>Methods</h4>Here we report of a 62 years old patient with chronic debilitating and recalcitrant pemphigus not responding to several previous treatments, who received treatment with apremilast over a period of 32 weeks. The gene discussed is PDE4A; the disease is pemphigus.