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Open Access Highly Accessed Case report

Successful treatment of recalcitrant cutaneous sarcoidosis with fumaric acid esters

Ute Nowack1, Thilo Gambichler1*, Christoph Hanefeld2, Ulrike Kastner1 and Peter Altmeyer1

Author Affiliations

1 Departments of Dermatology Ruhr-University Bochum, Bochum, Germany

2 Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany

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BMC Dermatology 2002, 2:15  doi:10.1186/1471-5945-2-15

Published: 24 December 2002

Abstract

Background

Sarcoidosis is a multisystem disease of unknown origin characterized by the formation of noncaseating granulomas, in particular in the lungs, lymph nodes, eyes, and skin. Systemic treatment for cutaneous sarcoidosis can be used for large disfiguring lesions, generalized involvement, or recalcitrant lesions that did not respond to topical therapy.

Case presentations

We report three patients with recalcitrant cutaneous sarcoidosis who were treated with oral fumaric acid esters (FAE). Three female patients presented with cutaneous sarcoidosis that have proved to be refractory to various therapies, including corticosteroids and chloroquine. We treated the patients with FAE in tablet form using two formulations differing in strength (Fumaderm® initial, Fumaderm®). Dosage of FAE was performed according to the standard therapy regimen for psoriasis patients. After treatment with FAE (4–12 months), a complete clearance of skin lesions was achieved in the three patients. The side effects observed in this trial correspond to the well-known spectrum of adverse effects of FAE (flush, minor gastrointestinal complaints, lymphopenia).

Conclusions

On the basis of our findings FAE therapy seems to be a safe and effective regimen for patients with recalcitrant cutaneous sarcoidosis. Nevertheless further investigations are necessary to confirm our preliminary results.