We have come a long way from the days of being able to offer nothing but a steroid cream and a moisturizer to treat eczema. If you suffered through itchy skin this winter thinking there was nothing new available to help you, think again!
There has been a lot of research on eczema over the past decade and we are reaping the benefits with many new therapeutic options.
Here is an overview of what’s new and what’s still to come.
Injectable Medications for Eczema Treatment:
These medications, called biologics, work by blocking specific signaling molecules involved in creating the itch and red skin of eczema. Because they have such specific targets in the immune system, they are very effective at stopping the symptoms of eczema, while minimizing unwanted side effects.
Dupixent (Dupilumab), the original biologic medication for treatment of eczema first approved in 2017 is still widely utilized as it is incredibly effective and safe. Dupixent targets two specific immune system messengers (Interleukins 4 and 13, IL-4 and IL-13) and, in addition to eczema, it is approved for treatment of eosinophilic esophagitis and an add-on treatment for asthma. It is approved for ages 6 months and up. Dosing ranges from injections every 2-4 weeks depending on age and weight.
Adbry (Tralokinumab), originally approved in 2021, is now approved for use in patients 12 and up. Adbry works very similarly to Dupixent above, but blocks only IL-13. This means it is only approved for the treatment of eczema, but it also allows for the option of less frequent dosing and fewer side effects.
Oral Medications for Eczema Treatment:
JAK inhibitors (Janus kinase):
The “JAK inhibitor” class of medications is a new and ever-expanding area of research in the dermatology universe. JAKs include a family of receptors that are found on the surface of cells. They are involved in passing a message sent from other cells along to the interior of the cell they’re attached to. There are many signals that can be relayed through these doorways. Importantly for their use in dermatology, they are involved in creating the red rash and itchy skin of eczema.
Because these receptors are also involved in transmission of signals for blood clotting, immune cell growth and function, and lipid metabolism, there are possible side effects. Though we have a growing base of data supporting the safety of these medications for treatment of skin conditions, baseline labs and follow up monitoring is required while taking JAK inhibitors. Additionally, having a history of certain medical conditions may mean that these medications are not safe for use.
Rinvoq (upadacitinib): a once daily pill, is an oral JAK 1 & 2 inhibitor approved by the FDA for atopic dermatitis in January 2022 in those 12 years and older.
Cibinqo (abrocitinib): a once daily pill, is an oral JAK1 inhibitor originally approved by the FDA in January 2022 for adults with refractory moderate to severe atopic dermatitis. Its approval was expanded to adolescents ages 12 and older in February 2023.
Non-steroidal Topical Medications for Eczema Treatment:
These medications work to decrease inflammation in the skin, thereby alleviating the itch and redness of eczema, while avoiding the side effects of topical steroid overuse. Steroids have historically been the first line of treatment for eczema because they are generally fast and effective while also being well-covered by insurance; however, their use must be limited because they can cause skin to thin with repeat use to the same location and adrenal insufficiency can be seen with extremely prolonged use.
We have had steroid-free options for a while now in the forms of Protopic (Tacrolimus), Elidel (Pimecrolimus), and Eucrisa (Criasborole). In 2021, we added Opzelura (Ruzolitinib) to the list of treatment options for those 12 and older. This is a JAK inhibitor, so works as the medications described above, but as a topical it is much safer because the internal absorption in the body is greatly reduced.
What to expect for eczema treatment in 2024
New-to-Eczema Nonsteroidal Topicals: Two medications that are already currently available and widely utilized for psoriasis are likely to be approved for use in eczema later this year.
Vtama 1% (tapinarof) cream works by a unique mechanism to stop itch and inflammation (technically, it is an aryl hydrocarbon receptor agonist. It supports healthy vascular function and pathways in the cell that break down toxins). It was FDA approved for adults in May 2022 for psoriasis. It has now shown positive results in Phase 3 trials in ages 2 and up for moderate to severe atopic dermatitis (eczema).
Zoryve 0.15% (Roflumilast) cream works to reduce inflammation by blocking an enzyme called PDE4. It is under review to add atopic dermatitis to its list of indications, as the 0.3% is already approved for psoriasis and seborrheic dermatitis. If approved, it will be available for ages 6 and up for the treatment of mild to moderate atopic dermatitis.
A New Biologic: Lebrikizumab, an injectable medication that works by blocking the signaling of interleukin 13, will likely be available later this year after showing great promise in phase 3 FDA trials. It will be approved for patients 12 and up with moderate to severe atopic dermatitis.