Treatment of severe psoriasis with fumaric acid esters: scientific background and guidelines for therapeutic use

Fumaric acid ester (FAE) therapy has proved to be safe and effective in pat ients with severe psoriasis vulgaris. This treatment was introduced nearly 30 years ago, but is only now gaining renewed interest among dermatologists , FAE therapy is licensed in Germany and registration is pending in many Eu ropean countries. Multicentre trials have confirmed the beneficial effect o f FAE in psoriasis and have defined the spectrum of its adverse effects, Al though the mode of action of FAEs in the treatment of psoriasis is not full y understood, recent experimental data point towards a skewing of the Th1-d ominated T-cell response in psoriasis to a Th2-like pattern, and inhibition of proliferation of keratinocytes. This article reviews the experimental a nd clinical information on FAEs in psoriasis and provides guidelines for th e clinical use of FAEs derived from a consensus meeting of leading experts.