Psoriasis Help Organisation - Online Psoriasis Forum

Fumaric Acid Esters

FAEs have been considered useful in the treatment of severe psoriasis in those who have had little success with other therapies for some time. It is only in the last decade or so that serious clinical research and studies have been made into both their effectiveness and the potential negative side effects.

FAES are complicated. Fumaric acid is contained in the plant Fumitory (Fumaria officinalis). Often Fumaric acid is called "free fumaric acid" in order to distinguish it from its salts and esters. Fumaric acid esters (II) differ from Fumaric acid by chemical groups called ‘esters’.

In healthy individuals, Fumaric acid is formed in the skin when it's exposed to sunlight. People with psoriasis appear to have a biochemical defect that requires prolonged exposure to the sun to produce it. However, there is no clinical evidence to show people with psoriasis need extra Fumaric acid in there system or need to supplement it as Fumaric acid is not effective in the treatment of psoriasis alone. It should not be used as a natural remedy or as a health supplement. In fact, it is a common additive to food stuffs, including sweets and cakes. The acids of the stomach in this case metabolise it to a harmless waste product.

However, a chemist can make acid esters from the base Fumaric acid, namely monoethylfumarate (MMF) and dimethylfumarate (DMF). It is these that have been researched, trialled and used as a therapy in psoriasis patients.

FAES are taken daily in capsule form before food and with water. The capsules are coated in an ‘anti-acid’ coating as the acids of the stomach can break the esters down to the useless Fumaric acid once again.

Trial evidence shows that a patient takes anywhere between 60-105 mg per day, gradually increasing to as much as 1,290 mg per day. Evidence also shows the higher the dose, the more likely the patient is to suffer side effects.

Reported side effects at trial level include gastrointestinal problems including nausea, cramps and diarrhea. Many reported flushing of the skin as the esters metabolised in the system, although this passes quickly. The most serious side effects are kidney disturbance and reduced function and white blood cell abnormality. It is therefore vital that monthly monitoring by blood test is done by a doctor to check the kidneys function and full blood count. However, these side effects are reversible once treatment is stopped.

Clinical trials across European countries have noted FAEs to be highly effective in both clearing Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients.

FAEs are licensed for use in Germany where Fumedica hold the license. However, other companies are holding trials and attempting to get licenses worldwide.

SJ May 2005

ZORAC (Tazarotene) Bioglan Limited

BETTAMOUSSE. Medeva Pharma Limited

Bettamousse, as the name suggests is a mousse formulation, so that you can deliver a 'blob of foam' to the area of your scalp you want to treat Bettamousse is a steroid product, and is obtainable from your doctor on prescription only

Patients with severe or disabling psoriasis may go to hospital or psoriasis treatment centres for concentrated treatment with UVB and topical coal tar. This is known as the Goeckerman regimen and usually takes at least three or four weeks of daily treatment.

The excimer laser is usually for mild to moderate levels of disease where lesions cover less that 10 per cent of the body. 

Pulsed dye lasers are also primarily used to treat small, localized areas of psoriasis. Instead of one continuous beam of light, they emit short bursts of high-intensity yellow light.

Side effects of laser treatment include a small risk of scarring and bruising.

GrenzlBucky rays are a form of very mild radiation with low penetration power: half of the rays are absorbed in the first half millimeter of the skin. 

It is used to calm down inflammation of the skin and will not cause damage as seen with prolonged use of corticosteroids. 

A typical course of Grenz/Bucky treatment consists of weekly or biweekly treatments over three or four sessions.