ABSTRACT
Fumaric acid esters have been used in the treatment of psoriasis for many years. Their use was proposed by Schweckendiek, a German chemist, in 1959. An oral formulation containing mono-ethylfumarate and dimethylfumarate (DMF) was later licensed as Fumaderm in Germany in 1994 and used several European countries as an unlicensed drug with good results. Following oral administration, DMF is rapidly metabolized by esterases in the small intestine to monomethyl fumarate, the active metabolite. The efficacy and long-term safety of DMF as used in Fumaderm is well-established. Long-term survival rates in real use of around 60% are similar to psoriasis biological drugs. DMF has been reported as effective in granuloma annulare, cutaneous sarcoidosis, alopecia areata and pityriasis rubra pilaris, although it is used in these conditions in an off-licence manner, based on case reports and case series only.
