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Fighting Pustular with Fumaric Acid Treatment
I have severe pustular P on both feet and the tips of my fingers.
My doctor has prescribed Fumaric Acid 5% ointment with Allantoin .5% mix.
When I used it,
it seemed to be a miracle, but now the feet are extremely red, full of
pustules and generally a real mess. To say the very least, I am
discouraged. Usually, come spring/summer, it clears up, but this year it
remains very bad. Perhaps it is because we are having an extra cold spring
so we are not outdoors as much.
I also have
P-arthritis and both ankles are so swollen, I frequently cannot get shoes
on. I also have severe arthritis in my hip and both knees. I feel quite
down in the dumps as I cannot even accompany my wife on her walks with the
dogs because of pain and limited mobility.
My wife and I
had been working out (before the feet got so bad) in a heated pool but the
SARS scare in Canada has closed the hospital to everyone but inpatients. I
will speak to my doctor about Fumaric Acid capsules. Actually, I live in
Kingston, Ontario, Canada but the Fumaric Acid comes from British Columbia
(over 3000 miles away).
dermatologist only had light therapy to offer. (I am sunlight sensitive
and broke out in a very itchy rash as well as burning my feet!) A friend
of ours who is a doctor, was kind enough to contact a pharmacist in
British Columbia, who suggested the Fumaric Acid compound.
Nice talking to
you because I feel so lost. I am 56, can't work and feel so frustrated.
Sincerely, -David F.
Response: I don’t know much
about fumaric acid treatment for psoriasis.
These two references provide some background (and each contains
isn’t used overtly for P treatment in the U.S., either orally or topically, but your experiences seem to suggest that like many
other P treatments, it works for awhile then its usefulness diminishes.
doctors said anything to you about methotrexate?
Down here it is the drug of choice when skin P is compounded by
near-debilitating P-arthritis. In
the late 90s my P arthritis got bad enough to threaten me with near
immobility — on top of which my skin lesions were flaming mightily —
and I finally started methotrexate (also referred to as MTX).
It completely quieted my arthritis and improved my skin
considerably (but not totally). (My
MTX Journal is here.)
Because MTX is
a toxic immunosuppressive drug, many doctors prefer to limit it as a
treatment course. Mine was one
of those doctors. We agreed at
the onset of treatment that I would not take the drug for longer than a
year. True to our commitment,
after a year of blessed relief I switched to another powerful systemic,
cyclosporine. Both the doctor
and I were fearful the P arthritis would come back.
But it didn’t. What’s
even better, the skin P that didn’t clear under MTX did
clear with cyclosporine. I
lived for nearly a year with absolutely no psoriasis symptoms.
I stopped the cyclosporine when my blood pressure began to rise.
[My Cyclosporine diary.]
I’ve been on a second course of MTX, again with good but not perfect
results. I phased out the MTX
early this year when I tried my first biologic
drug, Enbrel which has been bitterly disappointing.
Within the next few weeks my derm and I will have to decide on a
I share all
this with you, David, in the hopes that some of these more powerful drugs
are available to you. I think
for people with mild-to-moderate psoriasis, and perhaps even cranky but
not debilitating P-arthritis, the systemic immunosuppressive drugs are a
choice for which decisions can be made either way without stigma.
But when P becomes nearly debilitating, I feel more strongly that
the systemics should be considered. Unless
there are good reasons not to try them, I recommend they be considered.
I hope you’ll write again and let us know how you’re doing. -Ed