Fumaric acid is a food additive commonly included in sweet foods such as baked goods and dairy-based desserts. It is developed synthetically from malic acid, a substance in apples. Fumaric acid esters are chemicals derived from fumaric acid that have benefits for treating psoriasis, according to the New Zealand Dermatological Society (NZDS).
Psoriasis Identification
Psoriasis is a chronic disorder that causes skin cells to die and new ones to form more rapidly than normal. This leads to an accumulation of dead cells on the skin surface, forming thick silver scales and itchy, dry, red patches. The condition ranges from mild to disabling, and it also can involve arthritis. No cure has been discovered yet, according to the Mayo Clinic, but various treatments provide significant relief from symptoms. Topical treatments are most common, but more severe cases can be treated with oral or injected medications. People in Germany and some other European countries have used fumaric acid esters to treat psoriasis for many years, but this therapy has been slow to catch on in other parts of the world.
Effectiveness
Fumaric acid esters are effective for patients with severe psoriasis for whom other treatments have not worked, according to the NZDS. The society notes that psoriasis patients taking fumaric acid supplements can expect a 75 percent improvement in symptoms within four months. A study published in the "British Journal of Dermatolology" in September 2005 looked at 58 psoriasis patients who had taken fumaric acid esters, most of whom had tried other treatments previously. Fifty-five percent of these patients showed improvement, with 17 percent assessed as clear or virtually clear by the attending physician. However, 16 percent experienced worsening of symptoms. Fumaric acid esters also are being used in combination with drugs such as ciclosporin and methotrexate for additional benefits, or to allow the patient to reduce drug dosage.
Geography
Although health care practitioners have treated psoriasis patients with fumaric acid esters in northern Europe for many years, their use is unregistered or unlicensed in most countries outside of Germany, according to the NZDS. As of 2010, the only licensed fumaric acid ester is Fumaderm, a supplement that also includes calcium and magnesium. Germany approved use of Fumaderm for psoriasis treatment in 1994.
Side Effects
Gastrointestinal side effects are very common with fumaric acid esters, according to the NZDS, which notes that these effects lead to a high dropout rate in most clinical trials. Gastrointestinal effects occur in up to 60 percent of patients and include diarrhea, nausea, stomach cramps and abdominal pain. Flushing is another common side effect, occurring in 30 percent of patients. The "British Journal of Dermatology" study found that 15 percent of patients taking fumaric acid esters experienced malaise, or a general unwell feeling.
Warning
In the "British Journal of Dermatology" study, reduced levels of lymphocytes (a type of white blood cell) developed in 57 percent of patients. All these patients had normal values at the beginning of treatment. One patient experienced a severe enough drop in lymphocyte counts to be withdrawn from treatment. Additionally, some people have experienced reduced kidney function when taking fumaric acid esters, according to the NZDS. Both of these side effects are reversible when treatment is discontinued.
Considerations
Fumaric acid supplements are available and marketed as a natural alternative for psoriasis treatment. The NZDS cautions that these formulations are not the same as fumaric acid esters. They are poorly absorbed by the body and eliminated through urine, and they do not have a therapeutic effect on psoriasis.
