Fumaric Acid

What does it do?

Fumaric acid is related to malic acid, and, like malic acid, it is involved in the production of energy (in the form of adenosine triphosphate [ATP]) from food.

Fumaric acid has been used with some success to alleviate psoriasis symptoms.1 2 3 4 5 Typically, the amount used in these trials begins with 60-105 mg per day of fumaric acid esters, gradually increasing to as much as 1,290 mg per day.

Where is it found?

Fumaric acid is formed in the skin during exposure to sunlight, as well as being available as an oral supplement and as a preparation for topical use.

Fumaric acid has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating Health Concerns
3Stars

Psoriasis
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Who is likely to be deficient?

No deficiencies of fumaric acid have been reported. However, some doctors suggest that people with psoriasis may have a biochemical defect that interferes with adequate fumaric acid production in the skin.

How much is usually taken?

Only the esterified forms of fumaric acid are used therapeutically, such as fumaric acid monoethylester or fumaric acid di-methylester. Healthy people do not need to supplement with fumaric acid. Those using this substance (either orally or topically) should work with a dermatologist, since determining the optimal intake should be done on an individual basis. Even under these circumstances, supplementing should be started with small amounts (60–100 mg per day) and increased gradually over several weeks until an effect is noted.

Are there any side effects or interactions?

Kidney disorders have been reported in people taking fumaric acid esters, possibly due to taking large amounts too quickly.6 7 Most studies have reported gastrointestinal upset and skin flushing as common side effects; some have also found decreased white blood cell counts with prolonged use.8 9 .

At the time of writing, there were no well-known drug interactions with fumaric acid.

References

1. Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and side effects of 2 years of treatment. J Am Acad Dermatol 1992;27:769-71.

2. Altmeyer PJ, Matthes U, Pawlak F, et al. Antipsoriatic effect of fumaric acid derivatives. J Am Acad Dermatol 1994;30:977-81.

3. Mrowietz U, Christophers E, Altmeyer P. Treatment of psoriasis with fumaric acid esters: results of a prospective multicentre study. German Multicentre Study. Br J Dermatol 1998;138:456-60.

4. Nugteren-Huying WM, van der Schroeff JG, Hermans J, et al. Fumaric acid therapy in psoriasis; a double-blind, placebo-controlled study. Ned Tijdschr Geneeskd 1990;134:2387-91 [in Dutch].

5. Nieboer C, de Hoop D, van Loenen AC, et al. Systemic therapy with fumaric acid derivates: new possibilities in the treatment of psoriasis. J Am Acad Dermatol 1989;20:601-8.

6. Dalhoff K, Faerber P, Arnholdt H, et al. Acute kidney failure during psoriasis therapy with fumaric acid derivatives. Dtsch Med Wochenschr 1990;115:1014–7 [in German].

7. Roodnat JI, Christiaans MH, Nugteren-Huying WM, et al. Acute kidney insufficiency in patients treated with fumaric acid esters for psoriasis. Ned Tijdschr Geneeskd 1989;133:2623–6 [in Dutch].

8. Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and side effects of 2 years of treatment. J Am Acad Dermatol 1992;27:769–71.

9. Altmeyer P, Hartwig, R, Matthes U. Efficacy and safety profile of fumaric acid esters in oral long-term therapy with severe treatment refractory of psoriasis vulgaris. A study of 83 patients. Hautarzt 1996;47:190–6.