What to Do if Topical Steroids Aren’t Helping

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Unlike topical medications that affect only your skin, systemic medications work throughout your body, reducing inflammation that can lead to atopic dermatitis flares.

 There are several main categories of systemic medications for this condition, and each works on a different target to reduce inflammation.

JAK Inhibitors

In the same way that topical JAK inhibitors block the signals that trigger inflammation on the surface of your skin, oral medications reduce that response throughout your immune system.

 Options include abrocitinib (Cibinqo) and upadacitinib (Rinvoq). Baricitinib (Olumiant) may be used off-label, and other drugs are moving toward approval by the U.S. Food and Drug Administration for eczema treatment.

“With JAK inhibitors, you may not get clear skin right away, so it’s important to be patient, because it may take several weeks,” says Evans. “But the good news is that the itching tends to calm down soon after you start the medication.”

Biologics

These injectable medications target specific parts of your immune system, depending on which medication is used. Options include:

  • dupilumab (Dupixent)
  • lebrikizumab (Ebglyss)
  • nemolizumab (Nemluvio)
  • tralokinumab (Adbry)

They all work by blocking a type of chemical messenger, called an interleukin, to prevent it from binding to specific cell surface receptors. This action stops or minimizes part of your immune system’s response to a trigger, resulting in lower inflammation.

Immunosuppressants

Both JAK inhibitors and biologics are fairly new in terms of treatment options, and they’re being widely used because they don’t suppress the immune system like older medications, says Evans. But those more conventional treatments are still used in some cases when other options aren’t controlling atopic dermatitis effectively, and the symptoms are severe.

 Those choices are:

  • cyclosporine
  • methotrexate
  • azathioprine
  • mycophenolate

Oral corticosteroids like prednisone or prednisolone are generally not recommended, as they provide only temporary relief and can cause serious side effects. But they can be used in certain short-term situations.

“In the past, we only had immune suppressant medications like oral or injectable prednisone and cyclosporine that reduced the immune system,” Evans says. “Now we have so many options in terms of topical, oral, and systemic medications, and that’s exciting. It means both children and adults can often find a suitable treatment that controls their atopic dermatitis without dampening the entire immune system.”



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