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Macular exanthema due to fumaric acid esters
Claudia H Guenther1, Gottfried Wozel, Jörg Laske
1Klinik und Poliklinik für Dermatologie, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
The Annals of Pharmacotherapy
|January 29, 2003
Summary
An unusual allergic skin reaction, generalized pruritic exanthema, occurred in a patient treated with fumaric acid esters (FAE) for lichen planus. Oral rechallenge confirmed the probable adverse drug event, highlighting a potential allergic risk with FAE.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Medicine
Background:
- Fumaric acid esters (FAE) are used for systemic treatment of conditions like psoriasis vulgaris.
- Controlled trials demonstrate FAE's effectiveness and general tolerability, with common side effects including gastrointestinal issues and flushing.
- Allergic reactions to FAE have not been previously reported in medical literature.
Observation:
- A 68-year-old woman developed a generalized pruritic exanthema after 4 days of FAE treatment for lichen planus.
- The skin reaction resolved completely within 48-72 hours of discontinuing FAE.
- An objective causality assessment indicated a probable adverse drug event.
Findings:
- Oral rechallenge with FAE confirmed the drug-related origin of the exanthema.
- This case represents the first reported instance of an allergic skin reaction to fumaric acid esters.
- Skin testing for FAE allergy is not feasible, making rechallenge a crucial diagnostic step.
Implications:
- The possibility of allergic skin reactions should be considered in patients undergoing FAE therapy.
- This finding expands the known adverse effect profile of fumaric acid esters.
- Clinicians should be vigilant for cutaneous manifestations of drug allergy during FAE treatment.