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DescriptionIn addition, changes in the blood count may occur during the course of the treatment: mild or severe lymphopenia (approximately 50% or 3%), slight leukopenia (approximately 11%) or transient or very rarely persistent Eo-sinophilia. Increases in serum creatinine are observed. In the double blind study mentioned, the number of leukocytes and shampoo for seborrheic dermatitis lymphocytes decreased by an average of 10 to 20% under treatment with the antipsoriatics, whereas the eosinophil number significantly increased. However, serum creatinine, creatinine clearance and urea remained unaffected. Leuko- and lymphopenias were also observed in the long-term study, and in one case a pronounced eosinophilia was observed.

Effects on serum creatinine and creatinine clearance remained. In a study over two years, even 85% of the patients had lymphopenia. This was not associated with an increased infection rate [14]. It is not known whether lymphopenia that persists over a long period of time causes haematological or immunological disorders. At present, the treatment should not exceed six months outside of clinical trials. The high side-effect rate is primarily due to stressful but often tolerable and usually reversible symptoms. Most patients prefer these side effects to psoriasis.

Only a small percentage of the side effects result from treatment discontinuation: for example, eleven patients (l 3%) terminated the twelve-month study prematurely, eight of them for gastrointestinal side effects. Flushing symptoms did not lead to the discontinuation of therapy.

Treatment should be reserved for severe forms of psoriasis. The dosage must be carefully chosen and the patient should be thoroughly investigated. Kidney, liver, and blood are monitored by regular laboratory checks - only once every two, then every four, and finally every eight to twelve weeks. Under these conditions, Fumaderm® initial and Fumaderm® have a good safety profile, even in comparison with other system antipsoriatic agents.

interactions

Methotrexate, retinoids, psoralens, and cyclosporin should not be used concomitantly with the antipsoric drug. Furthermore, all immunosuppressants, cytostatics and drugs with adverse effects on how to cure seborrheic dermatitis the kidneys should not be used at the same time. The simultaneous external application of fumaric acid derivatives is to be avoided, which can lead to intoxications (renal damage) by exceeding the maximum tolerable dose.

Contraindications

The medicine should not be used in severe gastrointestinal disorders such as gastric and duodenal ulcer, severe liver and renal disease. Although there is no evidence of teratogenicity, the preparations should not be taken due to lack of experience during pregnancy. Since it is not known whether fumaric acid esters are excreted in the mother's milk, there should be no use during breastfeeding. Due to a lack of experience, the preparations are not used in patients under 18 years of age.

Clinical experience

The first major, well-founded clinical study on the therapy with fumaric acid derivatives was published in 1985. 32 patients were treated with mono- and dimethyl esters, of which 26 (82%) indicated the results as good to very good [8]. In 1989 Nieboer reported on the treatment of 192 patients with fumaric acid derivatives seborrheic dermatitis natural treatment in two open and three double-blind treatment approaches. A comparison of 240 mg dimethylfumaric acid ester and placebo showed significant differences in psoriasis and nail changes. This was not the case when mono-ethylfumaric acid ester and placebo were compared.
Created11 Oct 2017
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