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Eczema is a blanket term for a number of different types of dermatitis or “itchy skin rashes” These types include: atopic dermatitis, contact dermatitis, nummular eczema, dyshidrotic eczema and seborrheic dermatitis. Almost all types of eczema or dermatitis are characterized by redness and itching, with some causing blistering and peeling. Several treatment options are available for eczema, including, in some cases, phototherapy. Call our office at (248) 682-9611 to set up an appointment to find out which treatment option is best for your skin!
To learn more, visit https://nationaleczema.org/ or read the article below.
Available Eczema Treatments
There is no cure for eczema, but many treatments are available and more are on the horizon. In fact, there are currently an unprecedented number of new treatments for eczema in development. Some people with eczema find potential treatment by participating in clinical trials, the scientific process of developing new drug therapies. To learn more about these potential new therapies, visit Treatments in Development.
Depending on the type of eczema and severity, treatments include lifestyle changes, over-the-counter (OTC) remedies or prescription medication. Eczema symptoms can be different for everyone. Not everyone will respond to the same treatment plan in the same way, so it’s best to familiarize yourself with all of the options and consult with your healthcare provider to find a treatment regimen that works for you or your child.
For most types of eczema, managing the condition and its symptoms comes down to these basics:
- Know your triggers;
- Implement a regular bathing and moisturizing routine;
- Use over-the-counter (OTC) and/or prescription medications consistently and as prescribed;
- Watch for signs of skin infection — pus-filled bumps, pain, redness or heat.
Some other things you can do to help manage eczema symptoms: Cultivate a care team of healthcare providers to help you find the right treatment. Find an eczema expert in your area through NEA’s Provider Finder.
Try not to scratch and rub the affected skin — and limit contact with materials or substances that may irritate your skin and anywhere you are likely to flare-up. Dress in soft, breathable clothing and avoid itchy fabrics like wool that can further irritate your eczema. Avoid fabric detergents with known allergens. Recognize stressful situations and events — and learn to avoid or cope with them by using techniques for stress management. You may do this on your own or with the help of a trusted healthcare provider.
However, some people find that even when they do all the “right” things, their eczema still flares. Eczema (sometimes called “atopic eczema”) can be an unpredictable disease, and there is much still to learn about it. Having an eczema flare out of the blue is common and can happen despite your best efforts. Allergic reactions to environmental triggers can also lead to an eczema flare up (leading to “contact dermatitis” in some situations). For all treatments, be sure to consult with your healthcare provider to weigh the benefits vs. the risks to determine whether it is right for you.
Download our fact sheet on the basics of eczema skincare.
Bathing, Moisturizing and Wet Wraps
People with eczema tend to have very dry skin in general. This is because the disease causes defects in the stratum corneum, or the skin barrier. The skin barrier is the outermost layer of the skin that serves a dual purpose: it protects irritants, bacteria, viruses and allergens from getting into our bodies and it keeps moisture from getting out. Genes, skin trauma — such as from scratching or rubbing — and inflammation caused by the immune system can all contribute to this defective or “leaky” skin barrier in people with eczema.
The most effective way to treat dry itchy skin is to give it the moisture it needs and help it to retain it. Proper bathing and moisturizing are important for this reason — especially if you have eczema. The best way to replace and retain moisture in the skin is to moisturize immediately after taking a bath or shower. Download our step-by-step eczema care fact sheet.
Tips for bathing and moisturizing with eczema
Although there have not been comparative studies to pinpoint the best frequency or duration of bathing, the “Soak and Seal” method of treating eczema is recommended by many healthcare providers to combat dry skin and reduce flares.
To get the full therapeutic benefit of Soak and Seal, follow these steps in order:
- Bathe or shower in lukewarm (not hot) water for a short period of time (about 5-10 minutes) at least once per day.
- Avoid scrubbing your skin with a washcloth or loofah.
- Use a gentle cleanser (not soap) that is unscented, fragrance-free and dye-free.
- Lightly pat dry with a towel leaving the skin damp. Do not rub the skin.
- Apply prescription topical medication to the affected areas of skin as directed.
- Liberally apply a high-oil content moisturizer all over the body to seal in moisture. Try to do this within 3 minutes to limit the amount of moisture lost from the skin.
Let the moisturizer absorb into the skin for a few minutes before dressing or applying wet wraps. Wear cotton gloves over your hands while you sleep to help lock in the moisturizer and prevent scratching. Visit our Product Directory for a list of cleansers and moisturizers that fulfill the requirements of NEA’s Seal of Acceptance program.
Not only will soaking in a tub of warm (not hot) water help your skin better absorb moisture, bathing can also relax your body and mind and help ease stress. There are also specific bath treatments that can relieve eczema symptoms, including the following.
Bath Oil: Using gentle oils in your bathwater can help keep you moisturized. Be sure to use oils that do not contain fragrances.
Baking Soda: Adding a quarter-cup of baking soda to your bath, or applying it to the skin directly in the form of a paste, is a common treatment used to help relieve itching.
Bleach: Data suggests mild bleach and water solution can decrease inflammation, itching and potentially the amount of Staphylococcus aureus bacteria on the skin, which can lead to skin infections in eczema. Use a half-cup of household bleach for a full tub of water, one-quarter cup for a half tub. Soak up to 10 minutes, then rinse off. Some healthcare providers suggest doing these two to three times per week. People with bleach sensitivities or allergic asthma that might be aggravated by chlorine fumes should consult with their healthcare provider before starting bleach bath therapy. Download our bleach bath instruction sheet.
Oatmeal: Adding colloidal oatmeal to your bath, or applying it to the skin directly in the form of a paste, is also a common treatment used to help relieve itching.
Salt: If you’re experiencing a severe flare, bathing may cause your skin to sting. Adding one cup of table salt to your bath water can help ease this symptom.
Apple Cider Vinegar: Add between one cup and one pint of vinegar to the bath. This also can be used as a wet dressing, as the vinegar is believed to have antimicrobial effects. Get the Facts on apple cider vinegar for eczema.
Tips when moisturizing
If you use a prescription topical medication, apply it as directed before you moisturize. Apply a thick layer of moisturizer all over your skin within three minutes of bathing or showering to lock in moisture and protect the skin barrier. Moisturize your skin at least twice a day. Soften moisturizer by rubbing it between your hands and then apply it to your body using the palm of your hand. If the moisturizer feels tacky on your skin, don’t remove the excess. It will be absorbed within a few minutes. Moisturize your hands every time you wash them or when they come into contact with water.
Finding the right moisturizer
Finding a moisturizer that works can be a challenge. What works for one person may not work for another and as the condition of your skin changes, so can the effectiveness of a product. A manufacturer may also change the formulation of a product periodically as well. Start with the National Eczema Association Seal of Acceptance™ to find moisturizers free of fragrance, dyes and other common allergens. Products on this list are recognized by NEA as suitable for care of eczema or sensitive skin. Moisturizers are classified as ointments, creams, lotions or skin barrier repair creams based on the amount of oil and water they contain. The more oil in a moisturizer, the better it usually is at treating eczema.
Ointments such as petroleum jelly and mineral oil are usually the first choice for eczema treatment as they have the highest oil content and are very good at sealing in moisture. If you don’t like how ointments feel on your skin, the next best alternative is a cream.
Creams are second to ointments in the amount of oil they contain and are also very good at sealing in moisture. Because they contain less oil, they are also less greasy to the touch. Be sure to read labels carefully — creams sometimes contain stabilizers or preservatives that can irritate your skin.
Lotions contain the least amount of oil. Because they are primarily made of water, lotions evaporate quickly and may contain preservatives that burn when applied to skin that’s scratched or broken. If your skin stings or burns after you apply a lotion, switching to a cream or ointment may help.
Skin barrier repair creams
Skin barrier repair creams are available by prescription and over the counter. They are infused with lipids and ceramides, which are naturally occurring substances found in healthy skin barriers that skin with eczema may lack. The lipids and ceramides found in skin barrier moisturizers form a protective layer on the skin to help lock in moisture while keeping out irritants. This allows eczema skin to heal and become more resistant to symptoms, including burning, dryness and itch.
Wet wrap therapy
During particularly intense eczema ﬂares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. While wet wrap therapy can be done at home, wet wraps specifically applied to the face use gauze and surgical netting and should be applied by medical professionals trained in this treatment.
Wet wraps are best done after bathing, moisturizing and applying medication. Use clean, preferably white, cotton clothing or gauze from a roll for the wet layer, and pajamas or a sweat suit on top as a dry layer. If the eczema is on the feet and/or hands, you can use cotton gloves or socks for the wet layer with vinyl gloves or food-grade plastic wrap as the dry layer.
To do wet wrap therapy, first moisten the clothing or gauze in warm water until they are slightly damp. Next, wrap the moist dressing around the affected area. Then gently wrap the dry layer over the wet one. Lastly, carefully put on loose-fitting clothing so as not to disturb the dressing. Leave wet wraps on for several hours or overnight, taking care not to let them dry out. Consult with a healthcare provider before starting wet wrap therapy. Download our wet wrap therapy instruction sheet.
Complementary and alternative treatments
Many people with eczema use skincare products and practices that are outside Western or conventional medical advice to help manage their symptoms. If you use these natural therapies or home remedies with doctor-prescribed medications, you are using a “complementary” method to manage your eczema. If you are using natural therapies in place of conventional medicine, you are using an “alternative” method of self-care for your eczema treatment.
Before you consider any kind of treatment, it’s important to understand what triggers your eczema. Learning about the skin irritants in your everyday surroundings can help you better manage the condition whether you use traditional medications, alternative therapies or both. The following complementary and alternative therapies have been studied and found to benefit certain symptoms of eczema in adults. Check with your healthcare provider if you are interested in trying alternative therapies on your child’s eczema.
Plant-based and other topicals
Studies show that applying coconut oil topically reduces the amount of staph bacteria on the skin, which reduces the chance of infection. Apply coconut oil once or twice a day to damp skin. Be sure to choose coconut oils that are “virgin” or “cold pressed.” This method of oil extraction does not use chemicals, which could further irritate skin. Get the facts on coconut oil.
Sunflower oil boosts the skin’s barrier function, helping it to retain moisture. It also has anti-inflammatory properties. Apply sunflower oil to adult skin twice a day, with one of those times being shortly after bathing while skin is still wet. Avoid using sunflower oil, if you have a known allergy to sunflower seeds.
Topical vitamin B12 has been shown to be effective on eczema symptoms in both adults and children. However, there is no commercial product as of this writing, and so it must be compounded. Dr. Peter Lio, a dermatologist at Chicago Integrative Eczema Center and member of the NEA Board of Directors and Scientific & Medical Advisory Council, shares this recipe for a B12 compound that was formally studied.
Topical B12 Cream:
- 0.07 g cyanocobalamin (vitamin B12);
- 46 g persea gratissima Oil (avocado oil);
- 45.42 g water;
- 8 g TEGO® Care PS or methyl glucose stearate (an emulsifier);
- 0.26 g potassium sorbate (a preservative);
- 0.25 g citric acid.
Some have simply mixed vitamin B12 powder into a moisturizer base so that the final concentration is 0.07%.
Vitamins and supplements
Individuals who are living with eczema or caring for loved ones with the disease sometimes turn to vitamins and nutritional supplements to try to help lower inflammation, boost the immune system or get a good night’s sleep. Here are some common vitamins and supplements people use to manage their eczema:
- Vitamin D
- Fish Oil
- Prebiotics and Probiotics
- Primrose oil
It’s important to understand that there are few clinical studies proving the efficacy of vitamins and supplements for eczema and what works for some people might not work for others. Certain vitamins and supplements may be harmful when taken together or with prescribed medication. Always check with your healthcare provider before trying a new vitamin or supplement, and make sure they’re aware of everything you’re taking or administering to a loved one with eczema.
Ancient wellness systems
Integrative medicine is gaining traction in the healthcare field, specifically the idea of balancing conventional “Western” treatments with complementary “Eastern” therapies for a whole-body approach to treating eczema. Certain cultures have been practicing intricate systems of holistic healing – like Traditional Chinese Medicine (TCM) and Indian Ayurvedic Medicine – for thousands of years. However despite this longevity, published data with use in eczema is currently limited.
Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is the ancient wellness practice of bringing all aspects of human health into balance. Practitioners believe in a vital life force called Qi that surges through the body, and when Qi becomes imbalanced, it can lead to illness or disease.
TCM incorporates several treatment modalities that are customized to an individual’s needs. These might include acupuncture or the practice of inserting fine needles into strategic points on the body; massage techniques like acupressure, cupping and Gua Sha; mind-body practices; and traditional Chinese herbs. TCM’s herbal arsenal includes more than 10,000 herbs, which are mainly found in the leaves, stems and roots of certain plants and can take the form of powders, liquids or topicals.
Ayurveda, which translates from Sanskrit as “knowledge of life,” is a system of medicine that began in India more than 5,000 years ago. Similar to TCM, Ayurvedic medicine seeks to bring the body into balance using a tailored set of tools that include herbs, oils, dietary changes, massage and mind-body practices like yoga and meditation.
In the Ayurvedic system, people have life forces called “doshas” that help determine what kind of mind-body imbalances they may be prone to. Ayurvedic practitioners use these doshas to describe how the body functions and how it might react to different factors, such as what you eat or what you put on your skin.
Stress is a known trigger for eczema flares. Though the exact relationship between stress and eczema is unknown, experts believe that when you experience a stressful situation, your body produces inflammation. And inflammation is an underlying cause of eczema. Techniques may include hypnosis or biofeedback, a technique you can use to learn to control some of your body’s functions, such as your heart rate.
Mindfulness meditation is a mental exercise that involves a person concentrating on a particular object, thought or activity in order to “train their brain” to stay focused on the present moment, with no judgment, in order to achieve mental clarity and a state of emotional calmness. Learn more about the benefits of meditation on eczema.
Yoga, qigong and tai Chi
Yoga, qigong and tai chi are all examples of ancient mind-body practices that combine breathing with body movement and meditation to attain focus, clarity and relaxation. Some individuals with eczema believe these gentle exercises have helped them reduce stress, lower inflammation and distract from itch.
Tai chi and qigong are martial art forms that combine graceful movements with diaphragmatic breathing to help circulate vital energy called Qi in order to achieve balance between the body and mind. Yoga is rooted in Ayurveda and based on a Hindu philosophy that combines deep, slow breathing (pranayama) with a series of poses (asanas) to help achieve balance, focus and inner peace.
acupressure and massage
Acupressure is similar to acupuncture but with physical pressure applied to certain points on the body, rather than needles, to unblock “life energy.” Limited studies show that acupressure can help relieve the symptoms of itch and lichenification, which is thick, leathery skin.
It is well known that massage helps relieve stress, which may then help reduce eczema flares. It’s important to go to a massage therapist who is accredited and experienced with working with people with non-contagious skin conditions. Prior to your appointment, check with your massage therapist to be sure the oils and lotions used will not trigger your eczema or make it worse. Bring your own if you are unsure.
Over-the-counter medicines for eczema
OTC eczema remedies are topical and oral medications you can buy without a prescription. You can find a range of OTC treatments that help with eczema symptoms such as itch, redness, irritation or rash. Other OTC treatments can help prevent flares and assist with sleep when night-time itch is keeping you awake. Many OTC products are available in both brand-name or generic forms.
Things to consider with OTC products
The U.S. Food and Drug Administration (FDA) decides whether a medicine is safe enough to sell over the counter. However, using OTC medicines still has potential risks. Some interact with other prescription or OTC medicines, supplements, foods or beverages. Others cause problems for people with certain medical conditions. Be sure to talk to your healthcare provider before taking any OTC medicines for eczema.
It’s important to correctly follow directions for OTC medicines and be careful when administering them to children. You should never take OTC eczema drugs for longer durations or in higher doses than the product label recommends.
Antihistamines and Pain Relievers
Atopic dermatitis (AD), the most common form of eczema is part of what’s known as the atopic triad (eczema, allergies and asthma). In fact, people with AD have a greater chance of developing comorbidities or related health conditions, namely asthma, hay fever and food allergies. To help combat itch and curb inflammation if you have allergies, a healthcare provider may suggest antihistamines. Some antihistamines also contain sedatives that can help people sleep.
Examples of OTC oral antihistamines include:
- Diphenhydramine (Benadryl, Siladryl, Unisom, Banophen, Sudafed);
- Chlorpheniramine (Chlor-Trimeton, Wal-Finate, Aller-Chlor);
- Cetirizine (Zyrtec, Aller-Tec, Alleroff, Cetiri-D);
- Loratadine (Claritin, Alavert, Wal-itin);
- Fexofenadine (Allegra, Aller-ease, Aller-Fex, Wal-Fex Allergy);
- Doxylamine (Unisom, Wal-Som, Ultra Sleep).
To address common eczema symptoms such as burning, pain and inflammation, a healthcare provider may also suggest OTC pain relievers such as:
- Acetaminophen (Tylenol);
- Nonsteroidal anti-inflammatory drugs including ibuprofen;
- (Motrin, Advil) or naproxen (Aleve, Naprosyn).
Topical OTC hydrocortisone is a low potency steroid and works on the skin by reducing irritation, itching and inflammation. OTC steroids come in many forms, including ointments, creams, lotions and gels. They are used for the temporary relief of itching and rashes caused by most types of eczema.
OTC hydrocortisone is usually applied one to four times a day for up to seven days. Follow the directions on the label carefully. Do not use OTC steroids more often or longer than recommended on the label or by your healthcare provider.
Even though it’s sold over the counter, hydrocortisone products may cause side effects including:
- Dry or cracked skin
- Change in skin color.
Medicated OTC shampoos containing ingredients such as ketoconazole, selenium sulfide, coal tar and zinc pyrithione help with symptoms of seborrheic dermatitis on the scalp (also known as dandruff). The active ingredients in OTC dandruff shampoos typically work by helping lift the seborrheic dermatitis scale from the scalp and/or provide an anti-fungal treatment to combat the overgrowth of a type of yeast called Malassezia. Malassezia is thought to contribute to the development of seborrheic dermatitis.
What are topicals?
Topical treatments, or “topicals,” for eczema are medications that are applied to the skin to manage symptoms and reduce inflammation. There are a few different types of topicals for eczema. The most common include prescription steroids in varying strengths, calcineurin inhibitors, PDE4 inhibitors and Janus kinase (JAK) inhibitors.
Topical JAK inhibitor
The inflammation of atopic dermatitis (AD) is caused in part by immune system messengers called cytokines that are increased in the blood and the skin. Several of these inflammatory cytokines exert their effects through a chemical signal pathway inside cells known as the JAK-STAT pathway (Janus Kinase-Signal transducer and activators of transcription). The JAK family has four members – JAK inhibitors can target one or more of these family members to block these immune signals and inhibit the inflammatory effect of key cytokines involved in AD. The following topical medication works by specifically blocking JAK1 and JAK2, two enzymes that are involved in several cytokine pathways that contribute to inflammation in the skin, itch, and skin barrier function. Reducing the activity of JAK1 and JAK2 in atopic dermatitis can lead to fewer and/or less severe signs and symptoms by reducing itch, rash, and skin redness.
One topical JAK inhibitor is available for use with eczema. Opzelura (ruxolitinib 1.5%) cream is a topical selective JAK inhibitor approved by the FDA for the short-term and non-continuous treatment of mild to moderate atopic dermatitis in non-immunocompromised (patients without weakened immune systems) adult and pediatric patients 12 years of age and older who disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Frequently asked questions about Opzelura (ruxolitinib 1.5%) cream are available here.
Topical calcineurin inhibitors
Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that work by stopping certain cells of the immune system from “switching on,” preventing eczema symptoms such as redness and itch and inflammation.
Two TCIs are available for use in eczema, tacrolimus ointment (Protopic® and generic options) and pimecrolimus cream (Elidel® and generic options). Tacrolimus is FDA-approved in two concentrations for moderate to severe atopic dermatitis, one for children age 2-15 years of age, and one for adults. Pimecrolimus is FDA-approved for adults and children 2 years of age and older with mild to moderate atopic dermatitis. Your healthcare provider may additionally prescribe TCIs “off-label” to treat your eczema.
TCIs can be applied to all affected areas of the skin, including areas of delicate or thinner skin such as the face, eyelids, genitals, or skin folds, where the short- or long-term use of topical steroids may not be preferred. TCIs can be used for extended periods of time to control symptoms and reduce flares. Common side effects with TCIs include mild burning or stinging sensation when the medication is first applied to the skin.
In 2006, the FDA implemented a black box warning for TCIs regarding long-term safety and a possible risk of lymphoma (a type of blood cancer). To date, a causal link between TCIs use in eczema and these cancers has not been shown. However, this risk should be discussed with your healthcare provider.
Topical PDE4 inhibitors
Phosphodiesterase 4 (PDE4) is an enzyme that works inside cells in our immune system in the production of different inflammatory cytokines. Cytokines are proteins also produced by different immune system cells that contribute to a normal immune response. When cytokines are mistakenly triggered in the body, the resulting inflammation can contribute to the development of certain diseases, including atopic dermatitis. Blocking PDE-4 hinders the production of several cytokines that are involved in the inflammation of atopic dermatitis.
Currently, there is one FDA-approved topical PDE4 inhibitor for atopic dermatitis. Crisaborole (Eucrisa®) is an ointment available for adults and children with mild to moderate atopic dermatitis ages 3 months and up. Frequently asked questions about Crisaborole are available here.
One of the most commonly prescribed medications for all types of eczema is topical corticosteroids, or steroids for short, which can reduce inflammation and itching so that the skin can begin to heal.
Steroids are naturally occurring substances that our bodies make in order to regulate growth and immune function. Corticosteroids have been used for more than 60 years in topical medications to treat many kinds of inflammatory skin conditions including eczema. Topical steroids are used for eczema in adults and children.
Topical steroids are classified by their strength (or potency), which ranges from “super potent” (Class 1), to “least potent” (Class 7). There are a number of different topical steroid types as well as different concentrations, and dosage forms (ointment, cream, lotion, spray). Only apply the steroid to eczema-affected areas of your skin at the frequency prescribed by your doctor. Moisturizers can be applied on top of steroids. Certain areas or types of skin — the face, genitals, skin folds, raw or thin skin, and areas that rub together, such as beneath the breasts, or between the buttocks or thighs — absorb more medication and care must be taken when using steroids in these areas.
Once inflammation is under control, reduce or stop using the steroid per your physician’s instructions. If you are using high-potency steroids and/or have been using steroids for a long time, please consult your healthcare provider to avoid the risk of a “rebound” flare after stopping the medication.
As with any medication, there can be side effects to using topical steroids. The risk of side effects is related to the potency of the steroid, location and duration of use. Many of the potential side effects will resolve after stopping use of topical steroids. Common side effects of topical steroids include:
- Thinning of the skin (atrophy)
- Stretch marks (striae)
- Spider veins (telangiectasia)
- Perioral dermatitis (around the mouth)
- Acne or rosacea-like rashes.
Rare side effects of topical steroids may include:
- Hypothalamic-pituitary-adrenal axis suppression;
- Growth retardation in young children;
- Glaucoma (damage to the eye’s optic nerve);
- Cataracts (clouding of the eye lens);
- Topical Steroid Withdrawal.
Corticosteroids, including topical corticosteroids (TCS), are associated with a potentially serious condition called Topical Steroid Withdrawal (TSW). TSW is thought to be rare but can be debilitating for some patients. It may not be recognized by all health professionals as clear diagnostic criteria do not yet exist. Learn more about TSW and appropriate use of TCS. Visit our New Prescription Treatments hub to learn about newly-approved eczema treatments.
Prescription Injectables – Biologics
What are biologics?
Biologic drugs, or “biologics,” are among the most targeted therapies available today because they essentially use human DNA to treat certain diseases at the immune system level. Taken subcutaneously (through the skin) or intravenously (in the vein), biologics are genetically engineered medications that contain proteins derived from living tissues or cells cultured in a laboratory.
How do biologics work?
The immune system produces a certain type of protein chemical messenger called an interleukin, abbreviated IL, that helps our body fight off harmful viruses and bacteria. But for people with inflammatory diseases like atopic dermatitis, the immune system overreacts and triggers the release of certain ILs resulting in inflammation. This chronic inflammation leads to itchy, red patches on the skin and other symptoms common to many types of eczema.
Biologics for atopic dermatitis block specific ILs from binding to their cell surface receptors, which stops or limits that part of the immune system response. A calmer immune system means lower or less severe inflammation and therefore fewer symptoms of atopic dermatitis.
Dupixent® (dupilumab) is a biologic medication approved by the FDA for adults and children aged 6 years and up with moderate to severe atopic dermatitis for whom topical treatments have not worked or are not advised. Frequently asked questions about Dupixent are available here.
Visit our New Prescription Treatments hub to learn about newly-approved prescription eczema treatments. Adbry (tralokinumab-ldrm) is a biologic drug approved by the FDA for adults (18+ years) with moderate to severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies used on the skin (topical therapies) or when those therapies are not advisable. Frequently asked questions about Adbry are available here.
While the exact cause of eczema is not known, researchers understand that the immune system is involved. In eczema, the immune system overreacts and produces inflammation, which leads to symptoms such as itching, irritation and skin barrier problems.
If you have moderate to severe eczema, your doctor may prescribe a type of medication called an immunosuppressant, which helps control or suppress the immune system in order to slow down the symptoms of eczema.
Immunosuppressants are prescribed for moderate to severe atopic dermatitis (AD) in children and adults. They can be used to help stop the itch-scratch cycle of eczema, to allow the skin to heal and reduce the risk of skin infection. There are a number of immunosuppressants, both traditional systemic medications and steroids, used for treating eczema
The inflammation of AD is caused in part by immune system messengers called cytokines that are increased in the blood and the skin. Several of these inflammatory cytokines exert their effects through a chemical signal pathway inside cells known as the JAK-STAT pathway (Janus Kinase-Signal transducer and activators of transcription). The JAK family has four members – JAK inhibitors can target one or more of these family members to block these immune signals and inhibit the inflammatory effect of key cytokines involved in AD. The following oral medications work by selectively blocking JAK1, which is a JAK family member associated with several cytokines and other pathways that drive inflammation and itch in AD.
Cibinqo (abrocitinib) is an oral JAK1 inhibitor approved by the FDA for adults with refractory moderate to severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is inadvisable. The FDA approved Cibinqo in January 2022. Frequently asked questions about Cibinqo are available here.
Rinvoq (upadacitinib) is an oral JAK1 inhibitor approved by the FDA for adults and adolescents aged 12+ years with moderate to severe AD whose disease is not adequately controlled with other system drug products, including biologics, or when use of those therapies is inadvisable. The FDA approved Rinvoq for AD in January 2022. Frequently asked questions about Rinvoq are available here.
Traditional systemic medications
Among the most common traditional systemic medications used to treat eczema are:
- Azathioprine is an oral medication first used in transplant patients to prevent the body from rejecting a transplanted organ.
- Cyclosporine is an oral or injectable medication first used in transplant patients to prevent the body from rejecting a transplanted organ.
- Methotrexate is an oral or injectable medication used frequently in psoriasis and different types of arthritis. It is a chemotherapy agent first used on cancer patients.
- Mycophenolate mofetil is used in transplant patients and for other diseases of the immune system.
These medications are considered “off-label,” which means that it’s not approved by the U.S. Food and Drug Administration (FDA) to specifically treat atopic dermatitis and other forms of eczema. Immunosuppressants have the potential for serious side effects, including:
- Increased risk of infections;
- Upset stomach and vomiting;
- Increased risk for certain types of cancers;
- Increased blood pressure with cyclosporine;
- Increased risk of kidney damage with cyclosporine and methotrexate;
- Risk of liver damage with methotrexate.
Your healthcare provider will determine what baseline and ongoing monitoring exams and/or tests are needed when considering and using these medications.
In general, immunosuppressants are used for a short period of time to get the eczema under control, then tapered off or switched to topical medications for long-term eczema management. For many people, the improvement in their eczema on immunosuppressants helps to control symptoms with topical medications in the long term.
Steroids are also immunosuppressants and, in severe cases of eczema, oral steroids such as prednisone may be prescribed to control inflammation. However, they are not recommended by many healthcare providers due to the “rebound effect,” whereby the symptoms of eczema return, often worse, when the medication is discontinued. Long-term use (more than a month) of systemic steroids may result in serious side effects including:
- An increase in bacterial, fungal and viral infections;
- Skin thinning, stretch marks and acne;
- Hair loss;
- Weight gain;
- Glaucoma or cataracts;
- High blood pressure;
- Gastrointestinal issues;
- Stunted growth in children;
- Irregular menstruation.
According to the Clinical Guidelines for the Treatment of Atopic Dermatitis by the American Academy of Dermatology, “Systemic steroids should be avoided if possible for the treatment of atopic dermatitis. Their use should be exclusively reserved for acute, severe exacerbations and as a short-term bridge therapy to other systemic, steroid-sparing therapy.”
If you are taking oral steroids for the short-term treatment of eczema, it’s important to work with your doctor to use and subsequently taper off this therapy appropriately and move to a longer-term treatment solution. Visit our New Prescription Treatments hub to learn about newly approved prescription eczema treatments.
Phototherapy, also called light therapy, means treatment with different wavelengths of ultraviolet (UV) light. It can be prescribed to treat many forms of eczema in adults and children and helps to reduce itch and inflammation.
Phototherapy is generally used for eczema that is all over the body (widespread) or for localized eczema (such as hands and feet) that has not improved with topical treatments. The most common type of phototherapy used to treat eczema is narrowband ultraviolet B (NB-UVB) light, although other options may be recommended by your healthcare provider, including those that use ultraviolet A (UVA) light. Treatment with phototherapy uses a special machine to emit either UVB or UVA light.
What should I expect with phototherapy?
During your visit, you will apply a moisturizing oil to the skin and stand in a large cabinet undressed except for underwear and goggles to protect the eyes. The light-emitting machine will be activated for a short time – usually just seconds to minutes – and it will either treat the entire body or just certain exposed areas. It may take one or two months of steady treatment with phototherapy to start to see improvement in eczema symptoms, and at that point, the frequency of the visits can sometimes be reduced or stopped for a period to see if the eczema is in remission.
Potential side effects of phototherapy include:
- Sunburn and skin tenderness (common);
- Premature skin aging (common);
- Photosensitive skin eruptions;
- Nonmelanoma skin cancer;
- Cataracts (from UVA treatment).
Visit our New Prescription Treatments hub to learn about newly-approved prescription eczema treatments.
Source: The National Eczema Organization https://nationaleczema.org/eczema/treatment/