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Immunosuppressants

systemic treatment for eczema

What are immunosuppressant medications?

While the exact cause of eczema is not known, researchers understand that that the immune system is involved. In eczema, the immune system overreacts and produces inflammation, which leads to symptoms such as itching, redness and skin barrier problems.

If you have severe eczema, your doctor may prescribe you a type medication called an immunosuppressant. An immunosuppressant drug helps control, or suppress, the immune system in order to slow down the symptoms of severe eczema.

Immunosuppressants are prescribed for moderate to severe atopic dermatitis in children and adults.

How do immunosuppressants work?

Immunosuppressants help to stop the itch-scratch cycle of eczema; allow the skin to heal; and reduce the risk of skin infection.

There are a number of immunosuppressants, but the three most commonly used for treating eczema are:

  • Azathioprine is an oral medication first used in transplant patients to prevent the body from rejecting a transplanted organ.
  • Cyclosporine is an oral or injectable medication first used to prevent the body from rejecting a transplanted organ.
  • Methotrexate is an oral or injectable medication used frequently in psoriasis and different types of arthritis. It is a chemotherapy agent, first used on cancer patients.
  • Mycophenolate mofetil is used in transplant patients and for other diseases of the immune system.

These medications are considered “off-label,” which means that it’s not approved by the Food and Drug Administration (FDA) to specifically treat atopic dermatitis and other forms of eczema.

What are the side effects of immunosuppressants?

Immunosuppressants have some potential side effects, including

  • Increased risk of infections
  • Upset stomach and vomiting
  • Increased risk for certain types of cancers
  • Increased blood pressure with cyclosporine
  • Increased risk of kidney damage with cyclosporine and methotrexate
  • Risk of liver damage with methotrexate

In general, immunosuppressants are used for some months to get the eczema under control, and then are tapered off. For many people, the improvement in their eczema on immunosuppressants helps to control symptoms with topical medications in the long term.

Oral and injectable steroids

In severe cases of eczema, oral or injectable steroids such as prednisone, may be prescribed to control inflammation. However they are not recommended for use by many health care providers due to the “rebound effect,” whereby the symptoms of eczema return, often worse, when the medication is discontinued. As well, long-term use (more than a month) of systemic steroids may result in serious side effects including:

  • An increase in bacterial, fungal and viral infections
  • Skin thinning, stretch marks and acne
  • Hair loss
  • Weight gain
  • Glaucoma or cataracts
  • High blood pressure
  • Gastrointestinal issues
  • Osteoporosis
  • Stunted growth in children
  • Irregular menstruation

According to the Clinical Guidelines for the Treatment of Atopic Dermatitis by the  American Academy of Dermatology, “Systemic steroids should be avoided if possible for the treatment of atopic dermatitis. Their use should be exclusively reserved for acute, severe exacerbations and as a short-term bridge therapy to other systemic, steroid-sparing therapy.

If you are taking oral or injectable steroids for the short-term treatment of eczema, it’s important to work with your doctor to use and subsequently taper off this therapy appropriately and move to a longer-term treatment solution.