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Polyneuropathy typically presents gradually, beginning with paresthesia known as burning feet, followed by gait disturbances and variable muscle weakness in the lower limbs ( In the CNS, thiamine deficiency can lead to Wernickes encephalopathy, characterized by nystagmus, ophthalmoplegia, mental status changes, and unsteady stance and gait, due to apoptotic cell death in sensitive brain areas, mainly areas with high metabolic requirement, causing symmetrically distributed lesions among structures such as the third and fourth ventricles, besides dorsomedial thalamus (42)

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These findings highlight apremilast as an effective long-term option for psoriasis management, particularly for patients who cannot tolerate biologics or require an oral alternative