fumarates and Leg-Dermatoses

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.. We sought to investigate the efficacy of FAE in a larger number of patients with NL.. 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.. 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.. The results of this study demonstrate that FAE are beneficial and safe in the treatment of patients with NL.

Topics: Adult; Aged; Aged, 80 and over; Dermatologic Agents; Dimethyl Fumarate; Drug Combinations; Female; Fumarates; Humans; Leg Dermatoses; Male; Middle Aged; Necrobiosis Lipoidica; Prospective Studies; Severity of Illness Index; Skin; Treatment Outcome; Ultrasonography

A small epidemic of severe contact dermatitis cases related to newly acquired sofas and chairs has surpassed the news threshold in Finland and the U.K.. To study affected patients and to identify the cause.. Five patients with contact dermatitis related to a newly purchased chair or sofa were studied. Furniture samples were analysed by gas chromatography-mass spectrometry. Compounds were identified using a mass spectrum library and measured semiquantitatively. Patch tests were performed with commercial standard allergens, furniture upholstery and chemicals found in the analysis.. Patch tests with commercial allergens did not solve the problem. Up to 470 microg kg(-1) of dimethylfumarate was found in chairs. The patients showed strong positive patch test reactions to upholstery fabric samples and to dimethylfumarate, down to a level of 1 p.p.m. in the most severe case.. The cause of the Chinese sofa/chair dermatitis epidemic is likely to be contact allergy to dimethylfumarate, a novel potent contact sensitizer.

Topics: Adult; Anti-Infective Agents; Arm; Back; Buttocks; Dermatitis, Contact; Dimethyl Fumarate; Female; Fumarates; Humans; Interior Design and Furnishings; Leg Dermatoses; Male; Middle Aged; Patch Tests