[Low-dose, long-term fumaric acid esters in recalcitrant cutaneous sarcoidosis : Report of two cases].

Fumaric acid esters lead to reduction of cell fusion and inhibition of giant cell formation in vitro, which is considered to be a reason for their therapeutic effect on cutaneous granulomatous diseases. We have reported that successful treatment of the skin lesions of a patient with recalcitrant systemic sarcoidosis with Fumaderm® (Biogen, Munich, Germany; 360-720 mg/day dimethyl fumarate) had to be discontinued due to the development of lymphocytopenia. Therefore, we treated two further patients with the low-dose Fumaderm® Initial (90 mg/day dimethyl fumarate) and observed a partial remission of the skin lesions over a minimum 18 month follow-up without signs of lymphocytopenia.