Topical Steroids and Other Types to Know

Anti-inflammatory medications aren’t limited to topical applications — some are also systemic oral or injected medications, which are classified as immunosuppressants.

Oral immunosuppressants

Immunosuppressants work by preventing the body’s immune system from activating the inflammatory skin response that’s the hallmark of atopic dermatitis, resulting in less itching, inflammation, and skin barrier problems. (8)

The most commonly used immunosuppressants for atopic dermatitis are cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil. When used for atopic dermatitis, immunosuppressants are considered “off-label” because they are not approved by the FDA to specifically treat the condition.

Though they are effective for some people, these medications are not advised for long-term use. The drugs carry a number of potentially serious side effects, including increased risk of certain cancers, increased blood pressure (cyclosporine), increased risk of kidney damage (cyclosporine and methotrexate), and risk of liver damage (methotrexate).

Injected Immunosuppressants (Biologics)

Biologic drugs, or biologics, are another type of systemic medication prescribed for atopic dermatitis. (9) The drugs work by blocking the activity of the protein interleukin, which normally helps the immune system fight off pathogens with inflammation but is triggered erroneously (and without the presence of pathogens) in people with atopic dermatitis and other inflammatory conditions.

Dupilumab (Dupixent) is the first biologic approved for the treatment of atopic dermatitis. In clinical trials, more than half of people who took Dupixent — which is injected under the skin every other week — had their symptoms reduced by 75 percent over the course of 16 weeks.

The FDA has approved Dupixent for children who are 6 months and above as well as adults.

Side effects for the biologic include:

Tralokinumab-ldrm (Adbry) is another biologic that has been approved for adults with moderate to severe atopic dermatitis. Adbry, which is injected every other week for the first 16 weeks of treatment and then injected every four weeks, can be used with or without topical corticosteroids.

Side effects include:

• Inflammation of the eye and eyelid
• Reaction at the injection site
• High count of a certain white blood cell called an eosinophil

Oral JAK Inhibitors

A new class of oral medication approved for treatment of moderate to severe atopic dermatitis are the JAK inhibitors upadacitinib (Rinvoq) and abrocitinib (Cibinqo). These medications can work quickly with good efficacy and tolerability. They have been shown to target the itch of atopic dermatitis particularly well.

The FDA has placed a box warning on these medications for potentially increasing the risk for all-cause mortality, serious infections, certain cancers (including lymphoma), heart attack, stroke, and thrombosis (blood clots).

Rinvoq and Cibinqo are not recommended for use in combination with other JAK inhibitors, biologics, or other immunosuppressants.

You should not breastfeed while taking abrocitinib or upadacitinib.