Fumaric Acid Therapy for Psoriasis

Active ingredients from an inconspicuous, red-flowered plant are currently the best-tested weapons against severe and moderate forms of psoriasis. The so-called fumaric acid esters from the “common fumitory” (Fumaris officinalis) were presented by Prof. Dr. Wolfram Sterry, president of the German Dermatological Society and head of the skin clinic at Berlin’s Charité hospital, as an effective and safe therapy even for severe cases of psoriasis. Thus, a few days ago at a continuing education event for dermatologists at the Universtäts-Hautklinik Tübingen, a drug that used to be assigned to outsider medicine became a standard drug of conventional medicine.

Psoriasis therapy: fumaric acid brings breakthrough

Prof. Sterry was able to report from everyday clinical practice at Charité that Fumaderm therapy is effective in nearly 90 percent of all patients treated with this agent. And because of its low spectrum of side effects, he said, it is also particularly suitable for the long-term treatment usually required for psoriatics. Psoriasis is a very common inflammatory skin disease, similar in incidence to diabetes mellitus. It is based on an imbalance of certain cells of the defense system (TH1 and TH2 cells). Fumaric acid esters from fumitory have an inhibitory effect on TH1 cells, which are produced in excess in psoriatics. The convincing effect of fumaric acid therapy is also based on this mechanism. Until then, fumitory and its effect on the immune system had been a wallflower, although its beneficial effect on skin diseases was well known. It is no coincidence that the shrub from which fumaric acid ester is extracted is also popularly known as “grindkraut”. In the past, tea compresses made from the plant were applied to the affected areas of the skin of psoriatic patients. Incidentally, fumitory is also mentioned as a medicinal herb in ancient times by the Roman poet Pliny and by the Greek physician Dioscorides. Recognize psoriasis: these pictures help!

Psoriasis: treatment against suffering.

Immunotherapy with fumaric acid esters seems to make a breakthrough in the treatment of psoriasis patients possible. This is because, according to a recent European study, many patients are dissatisfied with their therapy – not least because of the pressure of suffering, which was also reported in Tübingen by Dr. Monika Brück, senior physician at the University Dermatology Clinic there: “The quality of life of patients with psoriasis is considerably more restricted than previously assumed. Serious studies report that the quality of life of psoriasis patients is even more limited than that of heart attack and cancer patients.” However, social ostracism by society because of skin symptoms that are perceived as unsightly is only one of the factors. Also the physical suffering pressure is substantial: Psoriasis patients take twice as much pain medicines and sleeping tablets as healthy ones to itself , wrote the president of the European Psoriatiker organization EUROPSO, the Finn Seppo Heikki Salonen, in a publication. Because they cannot be helped sufficiently with conventional therapies, 62 per cent of the patients consulted two or more physicians within two years because of their illness. Fewer than half of all sufferers have used their prescription medications to date – because of a lack of efficacy or fear of side effects.

Psoriasis: therapy with fumaric acid esters.

The breakthrough of immunotherapy for psoriasis in recent years using fumaric acid esters may change patient behavior. These drugs were first approved for the treatment of severe forms of psoriasis by the German Federal Institute for Drugs and Medical Devices (BfArM) in 1994. Because of the influence on the immune system, research is also being conducted to determine whether other diseases based on disorders of the immune system can also be improved with fumaric acid esters. For example, multiple sclerosis is being considered. In the meantime, other possibilities of immunotherapy are also being researched. For example, in Tübingen, the new director of the University Dermatology Clinic there, Prof. Dr. Martin Röcken, reported on the use of interleukin 4 in psoriasis. Interleukins are messenger substances of the immune system that control reactions of the defense system. With the help of interleukin 4, according to Prof. Röcken, the defense mechanism, which is out of control in psoriasis, can be balanced.But until this treatment, currently still in the experimental stage, can be made available to broad swaths of patients, the fumaric acid ester from fumitory will claim the leading role among effective drugs.

Fumaric acid ester: side effects and efficacy

As before, only severe forms of psoriasis or those that do not respond to other treatments are treated with systemic (that is, internal) therapies. Topical (i.e., external) treatments, like phototherapy or climatherapy, have the advantage that they act on the locally affected area of skin and thus place less stress on the body as a whole. Critics point to recent studies suggesting that an early, anti-inflammatory, internal therapy method could possibly reduce the risk of concomitant diseases such as high blood pressure (and thus as a late consequence also stroke and heart attack), lipometabolic disorders and diabetes. The immunomodulating effect of fumaric acid ester causes an inhibition of uncontrolled cell proliferation – the formation of scales is reduced and inflammation is slowed down. In rare cases, psoriasis therapy with fumaric acid esters can also lead to side effects, although these usually only occur at the beginning of the therapy. These include changes in blood counts, gastrointestinal problems, flushing and facial redness. Careful medical monitoring is therefore essential during fumaric acid therapy.