Psoriasis Cure: Fumaric Acid
DISCLAIMER: CONSULT WITH A DOCTOR BEFORE DECIDING ON A TREATMENT PLAN FOR ANY OTHER DISEASE OR INJURY.
Fumaric acid is a substance that is naturally produced in the body when the skin is exposed to sunlight. It can also be taken internally as a supplement, and in Germany, Austria, and the Netherlands, it is a relatively common prescription treatment for psoriasis. In Germany, fumaric acid is sold under the brand name Fumaderm. The substance may also be referred to as DMF (dimethyl fumarate), which is an esterified form of fumaric acid.
Sources of Fumaric Acid
In the US, Europe, Australia, and New Zealand, fumaric acid is an approved food additive. It is at times a preservative, an artificial flavor, or even a coagulant/thickener. The synthetic version of fumaric acid is commonly derived from malic acid, a substance obtained from apples.
Fumaric acid also exists naturally in bolete mushrooms and Icelandic moss and lichen. It is also found in high quantities in the earth smoke plant (Fumaria officinalis). This plant was traditionally used to treat a variety of disorders, including kidney problems (it is a diuretic), constipation, arthritis, rheumatism, conjunctivitis, and eye infections. It is now sold in Austria, France, Spain, and Germany as a tea or herbal extract and is commonly used as a treatment for dyskinesia of the biliary duct. In these countries, it is also known to relieve urinary discomfort and digestive problems, specifically those related to the liver and gallbladder. 1
In Germany, Fumaderm is a licensed version of fumaric acid. It combines dimethyl fumarate (DMF) with calcium, magnesium, and zinc salts. In the US, a delayed-release DMF medication has been approved by the FDA for use in relapsing multiple sclerosis. In other parts of Europe and in the United States, there are also standardized fumaric acid supplements and creams available despite the fact that this substance isn’t yet approved by the main pharmaceutical governing bodies of these countries.
Administration of Fumaric Acid
Fumaric acid should only be taken in its esterified forms. Although it is made naturally in the body, individuals with psoriasis may benefit from taking fumaric acid supplements in oral form, or they may use a topical cream.
This study indicates that the maximum daily dosage of fumaric acid is 720mg. Many cases where renal issues occurred were preceded by dosages that exceeded 720mg. As long as dosages of fumaric acid didn’t go beyond this 720mg/day mark, most patients did not report kidney problems. One side effect for some patients was proteinuria, however this effect was easily reversible by only reducing or (later) eliminating the dosage of fumaric acid.
It is always advisable to combine fumaric acid with other psoriasis treatment methods, such as a diet free of nightshades, in order to effectively cure the disease. Many patients have reported success in treating their psoriasis breakouts when using fumaric acid, particularly when it is combined with other treatments.
Germany’s Fumaderm brand is available in 2 forms: Fumaderm Initial and Fumaderm Full Strength. The Fumaderm Initial contains 30mg of DMF per capsule, and the Fumaderm Full Strength contains 120mg of DMF per capsule. This page (https://www.guysandstthomas.nhs.uk/resources/patient-information/dermatology/fumaderm-to-treat-psoriasis.pdf) has a dosing table that is convenient for beginners. You do not have to be using Fumaderm to follow this dosing chart as a guide.
Start with a lower dose of fumaric acid and work your way up, increasing the dosage according to the chart. Stop increasing the dose if you start to experience too much gastrointestinal discomfort. A little bit of discomfort is common when first starting to take fumaric acid, but it shouldn’t be so uncomfortable that it interferes with your daily life. Gastrointestinal problems often go away after about 3 months of supplementation with fumaric acid, even if the dosage is not changed.
Although it seems that fumaric acid wouldn’t cause problems during pregnancy, because there are no studies done on this to date, the supplement isn’t recommended during pregnancy or lactation.
How Fumaric Acid Works
When fumaric acid is ingested in one of its esterized forms, dimethyl fumarate (otherwise known as DMF), it travels through the body down to the small intestines where it is hydrolyzed. When it is hydrolyzed, almost all the DMF turns into MMF (monomethyl fumarate). Only a small percentage of the DMF emerges in the urine of the person who took it, and it always emerges in the form of DMF-glutathione. Some of the DMF enters the blood circulation and combines with intracellular glutathione to create this substance. 3
This interaction takes away glutathione from circulating immune cells. Reduced glutathione in the immune cells causes these cells to frequently express an anti-inflammatory protein called heme oxygenase-1 (HO-1). This expression inhibits pro-inflammatory agents such as tumor necrosis factor-a (TNF-a), interleukin-12 (IL-12), and IL-23. Thus, inflammation can be brought down, which is part of the reason why experts think that fumaric acid works like it does to treat psoriasis. Fumaric acid also has a variety of other immunomodulating effects. 3
Effectiveness and Side Effects
Some studies have demonstrated that fumaric acid can be toxic to the kidneys if it is taken in large doses over the medium- to long-term. Thus, fumaric acid should not be used as a long-term solution, but rather as part of a healing protocol for psoriasis.
According to this study, adults with moderate to severe psoriasis experienced relief from symptoms when using fumaric acid esters as a treatment (in the form of Germany’s Fumaderm brand). At first, some patients experienced gastrointestinal discomfort (including stomach cramping, nausea, and diarrhea; these appear in approximately 60% of patients according to one study below), but by reducing the dose carefully, management of psoriasis symptoms was still possible even with a lower, less uncomfortable dose. Even in cases where the dose of fumaric acid was kept the same, symptoms generally reduced and eventually disappeared over the course of 3 months of taking the Fumaderm. Another symptom was flushing, and some people experienced headaches or fatigue. Edema and itching were less common symptoms. 2
This study (, also mentioned below again) found that the symptom of flushing occurred because the niacin receptors in the body responded to the fumaric acid. The gastrointestinal complaints were harder to pin down, with some saying it was an allergic response of sorts, others calling it an eosinophilic gastroenteritis problem, or a result of the fumaric acid-triggered release of tumor necrosis factor-A (TNF-a). 3
A series of studies comparing fumaric acid to placebo studies (or differences in the usage of fumaric acid) were able to successfully demonstrate that use of this substance did have a significant positive effect on psoriasis patients. In one study comparing one group taking an oral Fumaderm supplement with a placebo group, the group taking the fumaric acid showed a 50% decrease in the psoriasis area and severity index (PASI) over the course of approximately 2 weeks. Another group that received a combination of fumaric acid with artificial vitamin D showed a decrease of 76.1% over a similar time frame in comparison with a group only taking the oral fumaric acid (and not the artificial vitamin D). This was the greatest demonstration of improvement out of all the studies. 3
What this study indicates is that a fumaric acid supplement combined with a natural vitamin D3 supplement could help psoriasis patients significantly reduce their symptoms. Because both fumaric acid and vitamin D are produced by sunlight, it stands to reason that the production of fumaric acid and vitamin D in the body upon sun exposure is the real reason why sunlight is so effective for many psoriasis patients. Combining adequate sun exposure along with lower level supplementation of fumaric acid and higher level supplementation of vitamin D3 could have even more positive, long-term effects.
 European Medicines Agency, Committe on Herbal Medicine Products. (2011). Assessment Report on Fumaria officinalis L., herba. Retrieved May 20, 2021 from: https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-fumaria-officinalis-l-herba_en.pdf
 Smith, D. (2016). Fumaric acid esters for psoriasis: a systematic review. Retrieved May 20, 2021 from: https://pubmed.ncbi.nlm.nih.gov/27271164/
 Balak, M.W. Deepak. (2015). Fumaric acid esters in the management of psoriasis. Retrieved May 21, 2021 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683116/