ABSTRACT

This chapter presents classification & mode of action, indications & dermatological uses, formulations/presentation, dosages & suggested regimens, baseline investigations, considerations & monitoring, contraindications, cautions, important drug interactions, adverse effects & their management, use in special situations, and essential patient information of Fumaric acid ester (FAE). FAE were first reported as an effective treatment for psoriasis by the German chemist, Schweckendiek, in 1959. FAEs have immunomodulatory actions without being immunosuppressants. FAE therapy has been reported to benefit other dermatological diseases, including disseminated granuloma anulare, necrobiosis lipoidica and sarcoidosis. A meta-analysis of randomized controlled trials for moderate-to-severe psoriasis reported that FAE therapy had similar efficacy to methotrexate. Experience of combination therapy with FAE and methotrexate, psoralen, retinoids, ciclosporin or other systemic psoriasis therapy remains very limited and is not recommended, but may be considered in exceptional cases with close monitoring. FAE are not licensed for use in children and adolescents and experience in this age group is very limited.