Fumaric acid esters: an alternative systemic treatment for psoriasis

We report the successful clearance of severe chronic plaque psoriasis following treatment with fumaric acid esters (FAE) in two patients who had failed previous systemic therapy. FAE is gaining increasing acceptance for the treatment of psoriasis in countries such as Germany and the Netherlands, but at present remains unlicensed in Britain.     

Fumaric acid esters in the management of severe psoriasis

BACKGROUND: Fumaric acid esters (FAEs) offer an effective alternative to patients with psoriasis in whom other systemic agents are contraindicated or have failed. OBJECTIVE: We assessed the efficacy and side effect profile of FAEs in a group of patients with psoriasis. METHODS: A retrospective study was carried out on patients treated with FAEs over 21 months. Information was gathered from patients' notes. Dosage, response and side effects were recorded. RESULTS: In total, 31 patients were included. The mean age was 46.8 years. All patients had been treated with other modalities and 61.5% had received previous systemic treatment. There was good to excellent response in 58.6% of patients. Subjective side-effects were common (87.1%), and lymphopenia occurred in 61.3%. The drug was not tolerated by one-fifth of patients. CONCLUSION: The relatively low toxicity and absence of hepatotoxicity makes FAEs a reasonable first-line systemic treatment in selected patients with difficult psoriasis.     

Fumaric acid esters in psoriasis and multiple sclerosis

Fumaric acid esters (FAEs) are effective in patients with moderate to severe psoriasis. Recent studies also report the efficacy of one FAE component, dimethylfumarate, in relapsing forms of multiple sclerosis (MS). We describe the case of a patient with MS who developed severe plaque psoriasis during interferon‐β‐1a treatment for MS. The psoriasis was unresponsive to usual topical treatments and phototherapy. The patient was started on FAE 720 mg daily, with complete remission of the psoriatic lesions and neurological stabilization at follow‐up at 24 months. Our case suggests that FAEs could represent a therapeutic option for patients with MS who develop plaque psoriasis following exposure to immune‐modulating agents.     

Cutaneous extranodal NK/T‐cell lymphoma mimicking cellulitis an HIV positive patient without lymphopenia

We present the case of a 28‐year‐old male with a history of human immunodeficiency virus (HIV) with a 1‐month history of a steadily enlarging, firm painful lesion on the right posterior shoulder. The patient was initially treated for cellulitis given his clinical picture. Histopathologic examination revealed an angiocentric and dermal proliferation of markedly atypical lymphoid cells with numerous mitoses and apoptotic bodies along with broad zones of necrosis. Biopsy revealed the presentation to be consistent with NK/T‐cell lymphoma. The cutaneous lesions from NK/T‐cell lymphoma can often be initially mistaken for cellulitis, therefore this malignancy should be included on the differential in a patient HIV/acquired immune deficiency syndrome (AIDS).