THE ROLE OF FUMARIC ACID AND DERIVATIVES IN VARIOUS DERMATOLOGICAL DISEASES

Abstract

Donie G

Fumaric acid esters (FAE) are chemical compounds derived from the unsaturated dicarbonic acid, fumaric acid. Esters of fumaric acid (FAEs), namely monoethyl fumarate (MEF), monomethyl fumarate (MMF), diethyl fumarate (DEF) and dimethyl fumarate (DMF) are potent chemicals currently in use for the treatment of psoriasis in various European countries like Germany, Switzerland and The Netherlands.FAE have various immunomodulatory, anti-inflammatory, and anti-oxidative properties that have caused it to be a possible emerging treatment modality for patients suffering from the disease. In spite of its unlicensed state, it is being used in several other European countries as it has shown favourable results. Studies that have evaluated the efficacy of FAE in psoriasis alone include 10 randomized controlled trials and 38 observational studies in a combined total of 5,003 patients. Results show that the FAE efficacy and safety profile is promising.While fumaric acid and its derivatives may be in use mainly for the treatment of psoriasis, there are various off-label indications for the drug. These include granulomatous diseases like Sarcoidosis, Granuloma annulare, Necrobiosis lipoidica, Cheilitis granulomatosa and annular elastotic giant cell granuloma. Various small, non-controlled studies and various case reports have been studied which show promising results for the use of FAE in the treatment of diseases other than psoriasis.The safety profile of FAEs was marked and studied. Intolerable gastrointestinal complaints and flushing led to early treatment withdrawal in 6-40%. However these gradually improve after 3 months of treatment. Lymphocytopenia, eosinophilia, increased liver enzymes, and proteinuria were the most commonly reported side effects. However, disruption in treatment due to the same were seldom present. Studies with long-term data are much needed for further assessment. This review is aimed to shed light on the future prospects of including fumaric acid and its esters as a regular treatment modality for various dermatological diseases.