Advances in Eczema Treatment

In June 2022, the FDA approved dupilumab (Dupixent) for children as young as 6 months. This biologic is an interleukin inhibitor and blocks the effects of proteins called cytokines that increase inflammation, weaken the skin barrier, and cause severe itching.

In the last year, the FDA has approved three new eczema treatments in a class of drugs called Janus kinase (JAK) inhibitors. A fourth drug is under review. These drugs block JAK enzymes, which play a part in driving the abnormal immune responses that lead to eczema symptoms. 

Ruxolitinib (Opzelura) is a medicated cream you spread on your skin. This is a good option if you need treatment other than a topical steroid, but your eczema isn’t bad enough for oral medication. 

Doctors can prescribe one of the two newly approved oral JAK medications, abrocitinib (Cibinqo) and upadacitinib (Rinvoq), if you have severe eczema on a large part of your body and you’ve already tried a systemic eczema medication like a biologic. You take them once a day. 

If you can’t use cyclosporine as a treatment, there may be an alternative coming through the pipeline. Baricitinib (Olumiant) is another pill version of a JAK inhibitor still awaiting FDA approval. Doctors hope it can treat very severe eczema cases.

Tralokinumab (Adbry) is a second biologic drug to treat moderate to severe eczema in people ages 12 and older. Tralokinumab is an injectable drug that blocks certain proteins responsible for the inflammatory response that causes eczema symptoms.  

Roflumilast is a medicated cream that is a PDE4 inhibitor like crisaborole (Eucrisa), but studies show it may be even more potent. It is used to treat plaque psoriasis and atopic dermatitis in children and adults. 

Tapinarof is the first in a new class of topical drugs called therapeutic aryl hydrocarbon receptor modulating agents (TAMA). These drugs inhibit two pro-inflammatory pathways that lead to itchy, inflamed skin. Tapinarof is approved for treating plaque psoriasis and is in phase III trials for atopic dermatitis. 

Researchers are looking into whether treating “bad” bacteria on the skin by using “good” bacteria will help prevent damage to the skin barrier. Some clinical trials show promise for bacteriotherapy creams or sprays that reduce symptoms with fewer side effects such as stinging. 

Light therapy, or phototherapy, uses a machine with UV rays to slow down the inflammatory response in skin. Treatment typically involves UVB light or a combination of UVB and UVA light. Researchers are doing clinical trials to better understand which UV light or lights will work best.