title: Fumaric acid esters in necrobiosis lipoidica: results of a prospective noncontrolled study.
abstract: BACKGROUND
  Necrobiosis lipoidica (NL) is an uncommon granulomatous skin disease with association to diabetes mellitus. To date, no proven effective therapy for NL has been implemented. The standard treatment is topical application of corticosteroids, but numerous agents have been reported for NL, with varying degrees of success. In recent case reports, fumaric acid esters (FAE) have been reported to be effective in granulomatous skin diseases such as granuloma annulare, cutaneous sarcoidosis and NL.
  
  
  OBJECTIVE
  We sought to investigate the efficacy of FAE in a larger number of patients with NL.
  
  
  METHODS
  Eighteen patients with histopathologically proven NL were consecutively recruited into a prospective noncontrolled study. Dosage of FAE was given according to the standard therapy regimen for psoriasis. FAE were administered for at least 6 months. The treatment outcome was evaluated by means of clinical and histological scoring and 20-MHz ultrasound assessments.
  
  
  RESULTS
  Three patients discontinued therapy with FAE, while the remaining 15 patients finished the study. After a mean +/- SD treatment period of 7.7 +/- 2.9 months, a significant (P < 0.001) decrease in the mean +/- SD clinical score, from 7.4 +/- 1.8 at the beginning to 2.5 +/- 1.3 at the end of therapy, was observed. Significant clinical improvement of NL was accompanied by significant (P = 0.019) increase of dermal density as assessed by means of 20-MHz ultrasound, and significant (P = 0.011) reduction of the histological score. Adverse effects were moderate and consisted mainly of gastrointestinal complaints and flushing. During follow-up of at least 6 months, clinical outcome remained stable in all patients.
  
  
  CONCLUSIONS
  The results of this study demonstrate that FAE are beneficial and safe in the treatment of patients with NL.
authors.affiliation: Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kreuter
authors.forename: C
authors.initials: C
authors.lastname: Knierim
authors.forename: M
authors.initials: M
authors.lastname: Stücker
authors.forename: F
authors.initials: F
authors.lastname: Pawlak
authors.forename: S
authors.initials: S
authors.lastname: Rotterdam
authors.forename: P
authors.initials: P
authors.lastname: Altmeyer
authors.forename: T
authors.initials: T
authors.lastname: Gambichler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069462:Dimethyl Fumarate; D004338:Drug Combinations; D005260:Female; D005650:Fumarates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007868:Leg Dermatoses / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009335:Necrobiosis Lipoidica / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003879:Dermatologic Agents; D004338:Drug Combinations; D005650:Fumarates; D000069462:Dimethyl Fumarate; C061175:ethyl fumarate