Information On Fumaric Acid

Fumaric Acid (acidulant, antidermatitic, antihepatocarcinogenic, antioxidant, antipsoriac, antitumor) is used as a raw material for pharmaceutics, plasticizers, synthetic resins, and also used as foodstuff additive. Chemically it is an unsaturated dicarbonic acid and is part of the citric acid cycle.

As the citric acid cycle is the center for energy production within the cell, fumaric acid must be present in every cell of the body, being a by-product of the cycle. It is therefore not something that is foreign to the body. A lack of fumaric acid leads to the accumulation of half-products. These products, we believe, are responsible for the skin lesions in patients with Psoriasis. In administering the lacking fumaric acid slowly to the body, the Psoriasis can come to a halt. The administration of the acid should be slow, as it is a metabolically very active substance. However the administration of too little fumaric acid will result in a therapeutic failure, whereas too much can lead to heat waves and a drop in blood sugar. This is a very rare occurrence.

One very promising treatment for Psoriasis is based on the use of fumaric acid. Clinical investigations with this unsaturated dibasic acid have been conducted in University Medical Centers in Switzerland, West Germany, Japan and the Netherlands and the results are promising. Fumaric acid is the trans isomer of malic acid and an intermediate in the Krebs citric acid cycle. Fumaric acid has been used both topically and orally and a titration protocol has been suggested.

It should be clear from the start that "Fumaric Acid" per se, is useless, but that "Fumaric Acid Monoethylester" and "Fumaric Acid di-Methylester" are the proper medicines.

Those who sell "Fumaric Acid" alone for the treatment of Psoriasis are thereby misleading with a substance that will be of no effect whatsoever by itself.

Psoriasis is regarded as a disease resulting from a metabolic error, possibly a defect of fumaric acid metabolism. Fumaric acid is the trans isomer of malic acid. It is an important compound biochemically since it enters into the citric acid cycle. Fumarate is a by-product at certain stages in the arginine-urea cycle and in purine biosynthesis. Since the citric acid cycle is the center for energy production with the cell, fumaric acid must be present in every cell of the body as it is a by-product of the cycle. Although fumaric acid is not a foreign substance, it is metabolically very active.

In healthy individuals, fumaric acid is formed in the skin when it is exposed to sunlight (from the ultra-violet part of the spectrum). Apparently, patients suffering from Psoriasis have a biochemical defect in which they cannot produce enough fumaric acid and need prolonged exposure to the sun to produce it. This is one reason why patients frequently notice an improvement of their skin condition in the summer months and also explains, in part, the efficacy of PUVA treatment.

This protocol for the treatment of Psoriasis with fumaric acid capsules is based on several clinical studies conducted at the Beau Reveil Clinic in Leysin, Switzerland and the West End Hospital in den Haage, Netherlands. Studies were reported in the following journals: Ned. Tijdschr. Geneeskd., Gann, Med. Msch., Biochem. Pharm., Arch. Derm. Res. and Arch. Derm. Forsch.

The therapeutic effect and the side effects of fumaric acid derivatives used in treatment of psoriasis vulgaris have been subjects of controversy for more than 30 years. A total of 83 patients with severe psoriasis vulgaris were investigated, long-term open (12 months) clinical trial to evaluate the efficacy and safety profile of the fumaric acid ester preparations Fumaderm initial and Fumaderm. The antipsoriatic effect of the fumaric acid derivatives was clear, with a mean reduction of 76% in PASI. Adverse events were noted in 62% of the patients (mainly flushing and gastrointestinal complaints). These were dose-dependent and decreased in frequency in the course of the study. No severe adverse events occurred. We believe that of fumaric acid derivatives are indicated in cases of severe therapy-resistant psoriasis to and can be used even for long-term application.

Fumaric acid ester (FAE) therapy has proved to be safe and effective in patients 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 European countries. Multicentre trials have confirmed the beneficial effect of FAE in psoriasis and have defined the spectrum of its adverse effects. Although the mode of action of FAEs in the treatment of psoriasis is not fully understood, recent experimental data point towards a skewing of the Th1-dominated T-cell response in psoriasis to a TH1-like pattern, and inhibition of proliferation of keratinocytes.

The inhibitory effect of fumaric acid (FA) on hepatocarcinogenesis was examined in mice fed thioacetamide (TAA). A group of male ICR mice was fed TAA at a level of 0.035% in the diet for 40 weeks and then fed a basal diet for 48 weeks. Hepatic tumors developed in 11 of the 24 animals of this group and they were diagnosed as hepatocellular carcinomas. However, cirrhotic lesions and the enlargement of hepatocyte nucleoli were not as marked in mice as in previous findings in rats fed TAA. The effect of FA on the carcinogenesis was examined in a group of mice fed this compound at a level of 1% in a basal diet after ingestion of TAA. The inhibitory effect of FA on TAA carcinogenesis was so marked that no hepatic carcinomas were found in any of the 15 animals fed FA in combination with TAA.

Known Hazards: The substance irritates the eyes, the skin and the respiratory tract.

  • Helmut Christ, M.D. The Surprising Psoriasis Treatment!!! The Arthritis Trust
  • Peter Altmeyer, Roland Hartwig, Ulrich Matthes: Efficacy and safety profile of fumaric acid esters in oral long-term therapy of severe psoriasis vulgaris. An investigation of 83 patients. Hautarzt 47 (1996) 3, 190-196
  • Mrowietz U, Christophers E, Altmeyer P. Treatment of severe psoriasis with fumaric acid esters: scientific background and guidelines for therapeutic use. The German Fumaric Acid Ester Consensus Conference. Department of Dermatology, University of Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany. urowietz@dermatology.uni-kiel.de
  • Akao M, Kuroda K. Inhibitory effect of fumaric acid on hepatocarcinogenesis by thioacetamide in mice. Chem Pharm Bull (Tokyo) 1990 Jul;38(7):2012-4

Discuss It!