Premium
Severe recalcitrant cutaneous manifestations in systemic lupus erythematosus successfully treated with fumaric acid esters
Author(s) -
Saracino A.M.,
Orteu C.H.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14698
Subject(s) - medicine , dimethyl fumarate , dermatology , hydroxychloroquine , context (archaeology) , psoriasis , lupus erythematosus , combination therapy , systemic therapy , mycophenolate , fumaric acid , disease , immunology , surgery , pharmacology , multiple sclerosis , covid-19 , cancer , paleontology , chemistry , transplantation , antibody , organic chemistry , breast cancer , infectious disease (medical specialty) , biology
Summary Fumaric acid esters ( FAE s) have proven efficacy in the treatment of psoriasis and have been in use for decades. More recently, as their mechanism of action and abundant immunomodulatory effects become clearer, the potential benefits of treating other inflammatory skin conditions using FAE s are increasingly being recognized. The use of FAE s as combination systemic therapy has not been well studied and data are lacking regarding the safety and efficacy of this type of therapy. In this case report, three patients with severe, extensive and recalcitrant cutaneous manifestations of systemic lupus erythematosus ( SLE ) (one case of disseminated discoid lesions and two with severe chilblain lesions) were treated with Fumaderm ® (containing the FAE dimethylfumarate and monoethylhydrogen fumarate salts), after failing to respond to a multitude of other monotherapies and combination therapies. All patients showed a substantial clinical response when FAE s were added to their treatment, with concurrent improvements in quality‐of‐life instrument scores. The treatment was well tolerated in the context of systemic organ involvement and as combination therapy with other agents, such as hydroxychloroquine and mycophenolate mofetil. These cases of SLE illustrate the potential use of FAE s in severe, disfiguring and otherwise therapy‐resistant skin lesions, including, to our knowledge, the first two reported cases of FAE ‐treated chilblain lupus erythematosus.