Oral Tablet
AVAILABLE NOW
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EFFICACY
In a study of 387 patients (aged 12 years and older) with moderate to severe eczema, 63% of patients taking the higher dosage saw a 75% improvement in their eczema severity after 12 weeks (as measured by the EASI).
57% of patients had a significant improvement in itch after 12 weeks (4 points or greater measured by Pruritus NRS score).
SAFETY
In one study, the most common side effects included: nausea (20%), common cold (12%), and headaches (10%).
This medication also has black box warnings of serious infection, heart attacks, stroke, cancer and death.
EVIDENCE LEVEL
Abrocitinib has been well studied. There are over 100 published research articles on abrocitinib use for eczema.
AVAILABILITY
Approved in the US, Canada, UK, and Japan for individuals ages 12 years and older with moderate to severe eczema not responsive to other treatments.
For help paying for this treatment see: Pfizer’s Dermatology Patient Access
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EFFICACY
According to the 2014 American Academy of Dermatology (AAD) Guidelines, oral / systemic steroids are not recommended for use in children with eczema unless they are required to manage comorbid conditions (eg, asthma exacerbations) or are given as part of a short-term transition to a different treatment. This is due to side effects and safety concerns.
SAFETY
In one study, the most common side effects included flaring of eczema after discontinuation of the medication, suppression of the hypothalamus-pituitary-adrenal (HPA) axis*, stunted growth in children, weight gain, diabetes, cataract, and osteoporosis.
* HPA axis is an area of the brain that is responsible for producing cortisol, the stress hormone in the body.
In a systematic review and meta-analysis of 74 articles with 3,753 patients, 48% of patients taking oral corticosteroids experienced a flare in their eczema after discontinuing the medication and up to 48% experienced suppression of the adrenal glands.
There are many side effects associated with long term usage (>1 month).
EVIDENCE LEVEL
Oral / systemic steroids are not recommended for use in children with eczema, except under certain circumstances.
AVAILABILITY
Oral Corticosteroids are widely available, but are generally not recommended for children with eczema, with few exceptions. Learn more here.
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EFFICACY
In a 16-week study of 552 adolescents (aged 12-17 years) with moderate to severe eczema who participated in three different trials, up to 84% of patients taking upadacitinib at the highest dose experienced a 75% improvement in their eczema severity (as measured by the EASI).
In the same study, 38-57% of patients experienced significant itch reduction (4 points or greater measured by Pruritus NRS score) depending on the dosage of upadacitinib.
SAFETY
In one study, the most common side effects included: acne (10-16%), CPK elevation (2-10%), upper respiratory infections (2-10%), headaches (5-8%), and common cold (up to 10%).
This medication has black box warnings of serious infection, heart attacks, stroke, cancer and death. Learn more here.
EVIDENCE LEVEL
Upadacitinib has been well studied. There are over 100 published research articles on upadacitinib use for eczema.
AVAILABILITY
Approved in the US, European Union, Australia, and Japan for adults and adolescents ages 12 years and above with moderate to severe eczema who are candidates for systemic therapy.
For help paying for this treatment see: RINVOQ Complete patient support program
COMING SOON
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EFFICACY
In a study of 440 adult patients with moderate to severe eczema, 30% taking the higher dosage of baricitinib achieved a 75% improvement in their eczema after 16 weeks (as measured by the EASI).
Also, 25% of patients taking the higher dose experienced significant itch reduction (4 points or greater measured by Pruritus NRS score).
SAFETY
In one study, the most common side effects included: upper respiratory infections (8%), common cold (5%), and diarrhea (4%).
EVIDENCE LEVEL
Baricitinib has been well studied. There are over 100 published research articles on baricitinib use for eczema
AVAILABILITY
Approved in Europe, but still under investigation in the United States. There is an ongoing clinical trial study for pediatric patients ages 2-17 years with an estimated completion date in 2026.
CONVENTIONAL IMMUNOSUPPRESSANT DRUGS
Four treatments that suppress the immune system that have been used to treat eczema for decades. These are not approved for use for eczema and are prescribed off-label.
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EFFICACY
In a study of 42 adults with severe eczema, those who took azathioprine for 12 weeks had a 37% reduction in eczema severity (as measured by the EASI).
SAFETY
In a study of 82 children, the most common side effects included: liver inflammation (13%), skin infections (12%), and development of abnormal blood values (10%).
This medication requires regular blood work to monitor the liver and level of cells in the body.
EVIDENCE LEVEL
Azathioprine should be reserved for more severe cases that do not respond to other treatments. Read guidelines for its use here.
AVAILABILITY
It is not approved for use in eczema.
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EFFICACY
In a study of 63 children who received cyclosporine for four weeks, 35% had “excellent” symptom resolution as assessed by their doctors, while 29% experienced “good” results and 36% “poor."
In a study of adult and child patients, 73% of patients had improved their eczema from severe to none, mild, or moderate after using cyclosporine for three weeks-10 months.The majority of patients saw improvement in the first 2 weeks and achieved maximum benefit at 10 weeks.
SAFETY
In a study of 147 patients (aged 9-68 years old) with moderate to severe eczema, 7.6% taking the medication (n=61) developed high blood pressure, 4.9% had stomach upset, 1.6% had kidney damage, and 1.6% had increased hair growth.
This medication requires blood pressure checks and blood work to monitor kidney health.
EVIDENCE LEVEL
There are over 500 studies on cyclosporine. The American Academy Dermatology (AAD) states, “The long-term effectiveness of cyclosporine for AD cannot be determined based on the current literature”.
AVAILABILITY
Cyclosporine is used “off-label” for the short-term treatment of severe eczema in both children and adults in the US. It is licensed in Europe for the short-term treatment of severe eczema in adults. In Australia, it is approved for the treatment of severe eczema when other treatments are ineffective.
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EFFICACY
In a study comparing methotrexate and cyclosporine in kids ages 7-14 years with severe eczema, researchers found that children treated with methotrexate experienced a 49% reduction in severity after 12 weeks (measured by the SCORAD).
SAFETY
Possible side effects include: stomach upset and nausea, liver toxicity, headache, and fatigue.
In a study, 82% of patients experienced liver inflammation and 100% experienced stomach upset.
This medication requires periodic blood work to monitor for liver damage and the level of cells in the body.
EVIDENCE LEVEL
Methotrexate has not been well studied for use in eczema.
AVAILABILITY
While it is not approved for use in eczema, it is widely available and can be prescribed “off-label.”
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EFFICACY
In a systematic review of published studies, adult patients who used mycophenolate for an average of 34 weeks experienced a 38% reduction in their eczema severity (as measured by the SCORAD).
SAFETY
In one study, the most common side effects included: headaches (10.7%), stomach upset (10.7%), herpes infection (9.3%), abnormal liver function tests (7.9%), and sepsis and folliculitis (6.4%).
EVIDENCE LEVEL
There are limited published studies on Mycophenolate Mofetil. See American Academy Dermatology (AAD) Guideline.
AVAILABILITY
While it is not approved for use in eczema, it is widely available and can be prescribed “off-label.”