From the Guidelines
The most effective medications for modulating the immune system to treat eczema are biologics like dupilumab and JAK inhibitors such as upadacitinib and abrocitinib, which have been shown to be effective in reducing itch and improving skin appearance with fewer systemic side effects. Several medication classes can modulate the immune system to treat eczema, including:
- Topical corticosteroids, which reduce inflammation by suppressing immune responses, with options ranging from low-potency (hydrocortisone) to high-potency (clobetasol) formulations used for 1-2 weeks during flares 1
- Topical calcineurin inhibitors like tacrolimus and pimecrolimus, which inhibit T-cell activation and are steroid-sparing alternatives particularly useful for sensitive areas 1
- Systemic immunosuppressants, which may be necessary for moderate-to-severe cases, including oral corticosteroids (prednisone, short-term use only), cyclosporine (inhibits T-cell function), methotrexate (reduces inflammatory cell proliferation), azathioprine (suppresses T and B cells), and mycophenolate mofetil (inhibits lymphocyte proliferation)
- Newer biologics like dupilumab, which target specific immune pathways by blocking interleukin-4 and interleukin-13 receptors, effectively reducing itch and improving skin appearance with fewer systemic side effects 1
- JAK inhibitors such as upadacitinib and abrocitinib, which represent the newest class, blocking multiple cytokine pathways involved in eczema inflammation 1. These medications work by targeting different aspects of the overactive immune response that characterizes eczema, helping to break the itch-scratch cycle and restore normal skin barrier function.
From the Research
Medications that Modulate the Immune System to Treat Eczema
The following medications can modulate the immune system to treat eczema:
- Topical corticosteroids, which are classified as steroid medications 2
- Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, which are classified as immunomodulators 3, 4
- Janus kinase (JAK) inhibitors, such as ruxolitinib and delgocitinib, which are classified as small molecule treatments 5, 6
- Biological treatments, such as dupilumab, which is classified as a monoclonal antibody 5
Drug Classes
These medications belong to the following drug classes:
- Corticosteroids: potent and very potent topical steroids 2, 6
- Immunomodulators: tacrolimus, pimecrolimus, and other topical calcineurin inhibitors 3, 4
- Small molecule treatments: JAK inhibitors, such as ruxolitinib and delgocitinib 5, 6
- Monoclonal antibodies: dupilumab and other biological treatments 5
Key Findings
- Potent and very potent topical steroids, tacrolimus, and JAK inhibitors are ranked among the most effective treatments for improving patient-reported symptoms and clinician-reported signs of eczema 6
- Dupilumab is the most effective biological treatment for eczema, reducing eczema signs and symptoms in the short term for people with moderate to severe atopic eczema 5
- Topical calcineurin inhibitors, such as tacrolimus, may be more effective than weak topical corticosteroids in improving disease severity 3