If you’ve been living with severe eczema, you know that, when it flares, you develop “red, flaky patches that can occur throughout the body,” notes Marisa Garshick, MD, an assistant clinical professor of dermatology at Weill Cornell Medical Center and a dermatologist at MDCS Dermatology in New York City. “Severe eczema tends to be when the patches are thicker or more widespread or involve certain areas that can make it disruptive to quality of life.” If your itchiness is relentless, though, the NEA says it’s likely you have a severe form of the condition, regardless of where the patches are on your body. Currently, the available treatments for eczema — including oral medications, topical medications, and light therapy — each work in different ways to manage the condition and its symptoms. Here’s a closer look. Topical and oral steroids are frequently prescribed to treat the dry, itchy skin associated with eczema. But long-term use of these drugs, considered immunosuppressants, isn’t recommended, due to significant side effects ranging from skin thinning and stretch marks to weight gain, high blood pressure, and gastrointestinal (GI) problems. Immunosuppressants such as azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil are systemic drugs. As their name suggests, they’re designed to suppress the immune system in order to control the symptoms of eczema. It’s believed that an overreacting immune system causes the inflammation behind symptoms such as itching, irritation, and skin problems, according to the NEA. These immunosuppressants can also cause long-term side effects, including increased risk of infection, nausea and vomiting, and increased risk of certain types of cancers. As a result, they are generally recommended for short-term use to get eczema under control. If the treatment is effective, your dermatologist may gradually reduce your dose and then recommend switching to topical medications for long-term management. Light therapy, also called phototherapy, uses different wavelengths of ultraviolet (UV) light to quell the inflammation that can lead to eczema outbreaks, according to the American Academy of Dermatology. For this treatment, people stand in front of a light-emitting machine that is activated for a few seconds or minutes. There are potential side effects, however, including sunburns, premature skin aging, and skin cancer, according to the NEA. Research suggests that JAK enzymes play a role in driving the abnormal immune responses behind several complex autoimmune conditions, including eczema, by stimulating the production of inflammatory proteins called cytokines. JAK inhibitors are designed to disrupt the overactive JAK pathways seen in eczema and to limit the cytokines that cause inflammation, in turn curbing its symptoms. Although four JAK inhibitors have been evaluated for use in eczema, only three — upadacitinib (sold under the brand name Rinvoq), ruxolitinib (sold under the brand name Opzelura), and abrocitinib (sold under the brand name Cibinqo) — have received FDA approval for the condition. Another JAK inhibitor, baricitinib, is currently in clinical trials and has been approved to treat other conditions. Take some time to absorb all of this info and talk with your dermatologist to determine the best approach for you. Here are some things to consider.
