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Treatment of disseminated granuloma annulare with fumaric acid esters.

Kreuter A, Gambichler T, Altmeyer P, Brockmeyer NH - BMC Dermatol. (2002)

Bottom Line: With the exception of temporary lymphopenia, no adverse effects were observed.The patient remained in remission during a six-month follow up period.Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. a.kreuter@derma.de

ABSTRACT

Background: Granuloma annulare is a granulomatous disease of unknown etiology. Various therapies have been tried in disseminated granuloma annulare (DGA), including corticosteroids, several variants of psoralen plus ultraviolet-A radiation, ultraviolet- A1 radiation, systemic retinoids, and dapsone, with variable success. We report a patient with recalcitrant DGA who was treated with fumaric acid esters (FAE).

Case presentation: A 40-year old Caucasian woman presented with a 25-year history of recalcitrant DGA. On both legs and the abdomen there were erythematous annular plaques. She was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-month therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period.

Conclusions: Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of FAE in the management of DGA.

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Almost complete clearance of disseminated granuloma annulare after 3 months of therapy with fumaric acid esters.
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Figure 2: Almost complete clearance of disseminated granuloma annulare after 3 months of therapy with fumaric acid esters.

Mentions: Since the disease had been recalcitrant to various conventional therapies, we decided to start oral treatment with fumaric acid esters. The patient was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt), supplied as Fumaderm® initial and Fumaderm® (Fumedica GmbH, Herne, Germany) [6]. Dosage of FAE was performed according to the standard therapy regimen for psoriasis patients displayed in Table 1. After two months, a complete clearance of skin lesions on the abdomen was achieved. Long-standing lesions on the legs improved after three-month therapy (Fig. 2). No subjective side effects were observed during treatment. Regular laboratory investigations, including differentiate blood count and kidney function, did not revealed abnormal findings during therapy, with the exception of slight lymphocytopenia. After discontinuation of treatment with FAE the patient remained in remission during a six-month follow up period.


Treatment of disseminated granuloma annulare with fumaric acid esters.

Kreuter A, Gambichler T, Altmeyer P, Brockmeyer NH - BMC Dermatol. (2002)

Almost complete clearance of disseminated granuloma annulare after 3 months of therapy with fumaric acid esters.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC101386&req=5

Figure 2: Almost complete clearance of disseminated granuloma annulare after 3 months of therapy with fumaric acid esters.
Mentions: Since the disease had been recalcitrant to various conventional therapies, we decided to start oral treatment with fumaric acid esters. The patient was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt), supplied as Fumaderm® initial and Fumaderm® (Fumedica GmbH, Herne, Germany) [6]. Dosage of FAE was performed according to the standard therapy regimen for psoriasis patients displayed in Table 1. After two months, a complete clearance of skin lesions on the abdomen was achieved. Long-standing lesions on the legs improved after three-month therapy (Fig. 2). No subjective side effects were observed during treatment. Regular laboratory investigations, including differentiate blood count and kidney function, did not revealed abnormal findings during therapy, with the exception of slight lymphocytopenia. After discontinuation of treatment with FAE the patient remained in remission during a six-month follow up period.

Bottom Line: With the exception of temporary lymphopenia, no adverse effects were observed.The patient remained in remission during a six-month follow up period.Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. a.kreuter@derma.de

ABSTRACT

Background: Granuloma annulare is a granulomatous disease of unknown etiology. Various therapies have been tried in disseminated granuloma annulare (DGA), including corticosteroids, several variants of psoralen plus ultraviolet-A radiation, ultraviolet- A1 radiation, systemic retinoids, and dapsone, with variable success. We report a patient with recalcitrant DGA who was treated with fumaric acid esters (FAE).

Case presentation: A 40-year old Caucasian woman presented with a 25-year history of recalcitrant DGA. On both legs and the abdomen there were erythematous annular plaques. She was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-month therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period.

Conclusions: Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of FAE in the management of DGA.

Show MeSH
Related in: MedlinePlus