Successful treatment of recalcitrant cutaneous sarcoidosis with fumaric acid esters

BACKGROUND: Sarcoidosis is a multisystem disease of unknown origin characterized by the formation of noncaseating granulomas, in particular in the lungs, lymph nodes, eyes, and skin. Systemic treatment for cutaneous sarcoidosis can be used for large disfiguring lesions, generalized involvement, or recalcitrant lesions that did not respond to topical therapy. CASE PRESENTATIONS: We report three patients with recalcitrant cutaneous sarcoidosis who were treated with oral fumaric acid esters (FAE). Three female patients presented with cutaneous sarcoidosis that have proved to be refractory to various therapies, including corticosteroids and chloroquine. We treated the patients with FAE in tablet form using two formulations differing in strength (Fumaderm(® )initial, Fumaderm(®)). Dosage of FAE was performed according to the standard therapy regimen for psoriasis patients. After treatment with FAE (4–12 months), a complete clearance of skin lesions was achieved in the three patients. The side effects observed in this trial correspond to the well-known spectrum of adverse effects of FAE (flush, minor gastrointestinal complaints, lymphopenia). CONCLUSIONS: On the basis of our findings FAE therapy seems to be a safe and effective regimen for patients with recalcitrant cutaneous sarcoidosis. Nevertheless further investigations are necessary to confirm our preliminary results

Performance of Family Firms: A Literature Review and Guidance for Future Research

This special issue ends with a comprehensive review article by Zellweger and Astrachan focused on understanding what we know about the ways in which family influence affects firm performance. Their literature review is organized along the dimensions of power, experience, and culture, through which a family can exert influence on a firm (Astrachan, Klein, Smyrnios 2002; Klein, Astrachan, Smyrnios 2005). André Hoffmann's commentary shares how the Hoffmann family has exercised its influence on the world's third largest pharmaceutical company, Roche Pharmaceuticals, for over a century. A combination of family involvement in ownership and governance of the firm has enabled the Hoffmann family to support the “Roche way of doing business”