You are not alone if you have atopic dermatitis, the most common form of eczema. This irritating, crusty, and inflammatory skin condition affects approximately 18 million individuals in the United States.
Some individuals are able to manage their eczema with moisturizers and topical treatments. However, advanced cases of atopic dermatitis typically require systemic medications that operate throughout the entire body and are prescribed by a physician.
There is evidence that an overactive immune system contributes to atopic dermatitis. This reaction causes skin inflammation, resulting in the typical symptoms of discoloration, itchiness, and irritation.
Due to a compromised skin barrier that is susceptible to allergens, dehydrated skin, and environmental irritants, individuals with atopic dermatitis may be susceptible to skin inflammation.
In moderate to severe cases of atopic dermatitis, your physician may prescribe immunosuppressive drugs. Included among these are azathioprine (Imuran), cyclosporine (Gengraf, Neural, and Sandimmune), methotrexate (Otrexup, Rasuvo, and RediTrex), and mycophenolate mofetil (CellCept).
Immunosuppressants can have significant adverse effects, including an increased risk of infection and organ damage. You can only use them for brief durations.
Newer treatments for atopic dermatitis include biologics. Rather than suppressing the entire immune system, biologics inhibit specific immune response pathways. This reduces or eliminates inflammation in specific areas and improves your symptoms.
Biologic medications dupilumab (Dupixent) and tralokinumab (Adbry) are used to treat advanced atopic dermatitis. They are administered subcutaneously once per week or once per month. Dupilumab is approved for adults and children older than 6 months, whereas tralokinumab is only approved for adults.
Possible adverse effects include injection site reactions, cold ulcers, and pink eye.
Janus kinase inhibitors
Janus kinase (JAK) inhibitors are an additional promising treatment for atopic dermatitis. They are available as a topical treatment to be applied twice daily or as an oral medication to be consumed once daily.
JAK enzymes transmit signals that can result in an abnormal immune response. JAK inhibitors prevent the transmission of these messages, reducing inflammation.
They work rapidly to alleviate the itching associated with atopic dermatitis and may help clean your skin substantially within a few weeks. Available JAK inhibitors are:
- abrocitinib (Cibinqo)
- upadacitinib (Rinvoq)
- ruxolitinib (Opzelura)
JAK inhibitors are generally well tolerated, but adverse effects such as cold symptoms, headaches, and vertigo are conceivable.
Selecting the most appropriate therapy for your atopic dermatitis
Your physician will assess the severity of your atopic dermatitis before recommending a treatment plan. Included in this are the following:
How much of your body is impacted which parts of your body are impacted?
The severity of your symptoms, such as weeping or skin enlargement, the frequency of their occurrence, and the impact on your daily life.
Your physician will evaluate your response to prior treatments. If your advanced atopic dermatitis has not responded to topical or first-line treatments, you may be a candidate for some of the newer medications.
In addition to your overall health and coexisting medical conditions, your eligibility for certain therapies will also be impacted by your overall health.
Not everyone responds the same way to therapies for atopic dermatitis. Your doctor may advise you to try various medications or combinations of medications to determine which improves your skin and alleviates your symptoms the most effectively. Multiple additional biologics and JAK inhibitors are undergoing clinical testing. In the near future, new pharmaceuticals will be available to further expand your options.