Atopic Dermatitis: When Steroids Don’t Work – Systemic Therapies & New Treatments
The Hidden Costs of “Fine Enough” Atopic Dermatitis Management
For many living with atopic dermatitis (AD), too known as eczema, finding a treatment that offers even partial relief can sense like a victory. But settling for “good enough” management – where symptoms are lessened but not fully controlled – may come at a significant cost, extending beyond just persistent skin irritation. Emerging therapies and a deeper understanding of the disease are shifting the landscape of AD care, suggesting that more aggressive and targeted approaches can offer substantial improvements in quality of life.
Atopic dermatitis is a chronic inflammatory skin condition characterized by itchy, inflamed skin. It often begins in childhood but can persist into adulthood, or even develop later in life. While topical treatments like corticosteroids are often the first line of defense, they don’t always provide sufficient relief, particularly in moderate to severe cases.
When Topical Treatments Aren’t Enough
Traditional approaches often involve escalating topical treatments, but this isn’t always the answer. Tanya Evans, MD, a dermatologist and medical director of the skin cancer program at the Melanoma Clinic at MemorialCare Saddleback Medical Center in Laguna Hills, California, explains that systemic therapy is generally considered when the disease is moderate to severe, with frequent or severe flares. Systemic therapies work throughout the body, rather than just on the skin, to address the underlying inflammation driving the condition.
But what does “systemic therapy” actually entail? The options are expanding, moving beyond older immunosuppressant drugs to newer, more targeted treatments.
JAK Inhibitors: A New Era in AD Treatment?
One of the most promising developments in recent years is the introduction of Janus kinase (JAK) inhibitors. These oral medications target specific inflammatory signaling pathways involved in AD, offering a more direct and often quicker reduction in inflammation and itch than traditional treatments. Approved options in the U.S. Include upadacitinib (Rinvoq) and abrocitinib (Cibinqo).
“New systemic therapies, especially JAK inhibitors, are transforming treatment for moderate to severe atopic dermatitis by offering rapid symptom relief and high efficacy,” explains Dr. Evans. However, she emphasizes the importance of careful consideration and ongoing monitoring. Like all medications, JAK inhibitors come with potential side effects, including nausea, high blood pressure, headache, diarrhea, and an increased risk of infections.
Beyond JAKs: Biologics and Other Systemic Options
While oral JAK inhibitors represent the newest class of systemic therapy, they aren’t the only option. Injected biologics – such as dupilumab (Dupixent), lebrikizumab (Ebglyss), tralokinumab (Adbry), and nemolizumab (Nemluvio) – offer another avenue for systemic treatment. These medications target specific parts of the immune system involved in the inflammatory process. Oral immunosuppressing drugs also remain a possibility, though they often come with a broader range of potential side effects. Everyday Health provides a consumer’s guide to biologics for atopic dermatitis, outlining how these treatments work and what to expect.
The Importance of a Holistic Approach
It’s crucial to understand that systemic therapies aren’t a standalone solution. They work best when combined with a comprehensive skincare routine. Maintaining a gentle, consistent skincare regimen remains essential to support the skin barrier and reduce irritation, even when someone starts an oral medication. This includes regular moisturizing, avoiding harsh cleansers, and minimizing known triggers.
This layered approach – addressing both internal inflammation with systemic therapies and external barrier support with diligent skincare – is key to achieving long-term control of atopic dermatitis.
Understanding the Risks and Benefits
The decision to pursue systemic therapy is a complex one that should be made in close consultation with a qualified dermatologist. It’s important to discuss the potential benefits and risks of each treatment option, as well as your individual medical history and lifestyle.
For example, the Food and Drug Administration (FDA) has required boxed warnings about increased risk of serious heart-related events and cancer with certain JAK inhibitors, highlighting the need for careful patient selection and monitoring.
What’s Next in Atopic Dermatitis Care?
Research into new and improved treatments for atopic dermatitis is ongoing. Clinical trials are exploring novel targets and delivery methods, with the goal of developing even more effective and well-tolerated therapies. The field is also increasingly focused on personalized medicine, tailoring treatment plans to the individual characteristics of each patient.
For those currently managing atopic dermatitis, staying informed about the latest advancements and proactively discussing treatment options with your dermatologist is essential. Don’t settle for “good enough” – explore all available options to achieve the best possible quality of life.
If you are experiencing symptoms of atopic dermatitis, consult with a board-certified dermatologist for diagnosis and treatment recommendations. You can find a dermatologist near you through the American Academy of Dermatology’s website.