Finding relief for severe eczema: new advanced treatments

Do you have intensely itchy, flaky skin that flares up during certain times of the year or in certain conditions? Does the itching get so bad it interrupts your sleep? Does your incessant scratching cause skin to crack, ooze or become infected?

If these symptoms sound familiar, you may have moderate to severe eczema. And you're not alone. Among the 31.6 million people living with eczema in the United States, 40% of adults and 33% of children have moderate to severe eczema.

What is eczema?

Eczema, also called atopic dermatitis, is a chronic, inflammatory skin condition. It causes itchy, painful rashes.

While the cause of eczema is unknown, doctors believe it's related to:

• genetics or family history of the condition;
• an overactive immune system that causes skin inflammation when exposed to allergens and irritants;
• a defective skin barrier that allows moisture to escape the body, and allergens and bacteria to enter.

Eczema can appear on the face, neck, hands, wrists, elbows, knees, ankles and feet. Common symptoms include:

• Red bumps, blisters or patches on light skin
• Brown, purple or ashen gray bumps, blisters or patches on dark skin
• Itchiness
• Dry skin
• Swelling
• Flaky, scaly or cracking skin
• Open, oozing skin
• Thickened skin
• Raw or sensitive skin due to scratching

When eczema is moderate to severe, symptoms are often widespread across the body. The inflammation causes intense, constant itching. This leads to the natural response of scratching. And unfortunately, too much scratching can then cause an infection if the surface of the skin is broken. Signs of an infection include crusty skin (often on top of the eczema), swollen bumps and pus-filled blisters.

Moderate to severe eczema can significantly impact your quality of life. It may affect your ability to do daily tasks and disrupt sleep at night.

How to manage and treat eczema

While there's no cure for eczema, treatments are available that can help reduce symptoms and break the itch-scratch cycle.

You can also take steps to avoid what triggers your symptoms. Because each person has specific triggers that may cause or worsen eczema, it's helpful to track and identify when and where your symptoms are at their worst. Typical eczema triggers include:

• Contact allergies to jewelry, cosmetics, cleaning or skin products
• Dry skin
• Dust mites that live in mattresses, carpets, pillows and furniture
• Environmental allergies like pollen or mold
• Food allergies to foods like tree nuts, shellfish or wheat
• Pet dander
• Hormonal changes around menstruation, pregnancy or menopause
• Outdoor temperatures including excessive heat or severe cold
• Skin irritants like heavy or tight clothing, certain fabrics or detergents
• Stress
• Cigarette smoke

It's common to have more than one trigger. Some may be easier to avoid than others.

If you're unable to identify your triggers, see a board-certified allergist or dermatologist for testing. These specialists can accurately pinpoint your triggers and recommend treatments.

The first line of treatment for mild to moderate eczema typically involves moisturizers and topical medications like corticosteroids, calcineurin inhibitors and PDE4 inhibitors. These medications help reduce skin inflammation, irritation and itch.

Advanced treatments for moderate to severe eczema

What can you do when eczema is moderate to severe and topical medications do not provide enough relief?

Ask your doctor about more advanced treatments. Biologic medications and Janus Kinase (JAK) inhibitors are two options. They target the source of eczema symptoms rather than the symptoms themselves, stopping skin inflammation at the cell level before it can start.

JAK inhibitors are approved to treat mild, moderate and severe atopic dermatitis in adults and children ages 12 and older whose symptoms are not adequately controlled with topical medications. Three JAK inhibitors are available for atopic dermatitis. Two are taken daily as a tablet or liquid. A third is a topical applied to affected skin twice a day — but on no more than 20% of the body.

Biologic medications dupilumab (Dupixent^®) and tralokinumab (Adbry^®) are approved to treat moderate to severe atopic dermatitis in people whose symptoms are not adequately controlled with all other medications. Dupilumab and tralokinumab prevent certain cells in the body from activating and causing skin inflammation.

Dupilumab is prescribed to adults and children ages 6 months and older. Tralokinumab is for adults and children 12 years of age and older. Both are given as injections every 1-4 weeks, either in the doctor's office or at home with an auto-injector pen. You can learn more about biologics for severe eczema at BiologicMeds.org.

Don't just put up with constant eczema symptoms when you can take action to start finding relief. See a board-certified allergist or dermatologist and ask about the latest treatments.