title: Successful treatment of recalcitrant cutaneous sarcoidosis with fumaric acid esters.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Dermatology, Ruhr-University Bochum, Bochum, Germany. UteNowack@web.de
authors.forename: Ute
authors.initials: U
authors.lastname: Nowack
authors.forename: Thilo
authors.initials: T
authors.lastname: Gambichler
authors.forename: Christoph
authors.initials: C
authors.lastname: Hanefeld
authors.forename: Ulrike
authors.initials: U
authors.lastname: Kastner
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
mesh_terms: D000328:Adult; D000069462:Dimethyl Fumarate; D005260:Female; D005650:Fumarates / Q000008:administration & dosage*; D006801:Humans; D012507:Sarcoidosis / Q000188:drug therapy*; D012871:Skin Diseases / Q000188:drug therapy*
chemical_list: D005650:Fumarates; D000069462:Dimethyl Fumarate; C061175:ethyl fumarate