Living With Eczema

Studies have found that patients who have eczema—also called atopic dermatitis, or AD—often report a decreased overall sense of well-being, known as quality of life, which is experienced to an even greater degree with moderate to severe disease.^1,2 Besides appropriate treatment, an understanding about the ways to improve daily living with eczema is essential to a comprehensive management approach.

Certain allergens found in the environment, such as dust and mold, can increase the risk of developing eczema.³ In the urban environment, additional allergens including pollution, household pests (for example, cockroaches and dust mites), tobacco smoke, and excessive heat may also trigger eczema.⁴ Maintaining skin moisture through proper skin care, such as applying unscented creams or lotions immediately after bathing, is important in helping prevent irritants and allergens from entering the skin.^1,3 Simply improving skin hydration may help reduce the need for and use of topical corticosteroids to control eczema symptoms.¹

Available treatments for eczema

Approaches to optimal management include additional personalized treatment options based on eczema severity. However, a mainstay of treatment for anyone affected by eczema includes gentle skin care, such as bathing or showering in warm (not hot) water, limiting bathing time to less than 10 minutes, and frequent use of moisturizers.³

If prescription intervention for mild to moderate flares is needed, topical corticosteroids (TCS) are typically used first at the affected area for a short duration.^1,3 Additional nonsteroidal options can include topical calcineurin inhibitors (TCIs) and phosphodiesterase-4 (PDE4) inhibitors.¹

Moderate to severe eczema may require treatments with phototherapy (light-based treatments) or possibly medications that affect the whole body, which are taken in pill or injectable form.^1,3 These types of medications targets different areas of the body’s immune system to help treat AD more aggressively.^1,3 A class of medications called biologics are injectable medications that target certain proteins (called interleukins) that regulate the immune response to help decrease inflammation that causes symptoms of AD.⁴ Dupilumab (targeting interleukins 4 and 13), lebrikizumab and tralokinumab (both targeting interleukin 13) are the only biologic medications currently approved to treat poorly controlled moderate to severe eczema.^1,5-7

Dupilumab is approved for the treatment of moderate to severe AD not controlled by prescription topical therapies or when such therapies cannot be used in patients 6 months and older.⁵ Studies of AD with moderate to severe hand involvement have also demonstrated improvements in cleared skin and reductions in itch.^5,8 Additionally, dupilumab can be used with or without TCS.⁵ Lebrikizumab and tralokinumab are also approved or the treatment of moderate to severe AD not controlled by prescription topical therapies or when such therapies cannot be used in patients 12 years and older, and can also be used with or without TCS.^6,7

In addition to biologics, other classes of medications are also used to treat AD. JAK inhibitors work by blocking certain signaling pathways inside the cell related to immune response.⁹ JAK inhibitors have unclear associations with increased risk for cancer, cardiovascular events and blood clots; due to safety concerns, this medication class is not considered first line therapy, but is approved for use in moderate to severe AD that has failed treatment with other immunosuppresants or injectable biologics, or when those other treatments are not advised.^9,10 Furthermore, oral JAK inhibitors should not be taken during pregnancy or while breast feeding.^9,10 Upadacitinib and abrocitinib are FDA-approved oral JAK inhibitors for the treatment of moderate to severe AD.¹⁰ Immunosuppressants such as oral corticosteroids and other off-label therapies including methotrexate, azathioprine, cyclosporine and mycophenolate mofetil can have side effects that require laboratory monitoring and limit how long they can be used.^10,13

Lifestyle approaches to managing eczema

With new ways of identifying eczema and evolving medications to treat it, patients now have additional methods to help manage their eczema. However, eczema also affects a patient’s lifestyle since it is such a visible problem that may affect the arms, neck, legs, head, and other areas of the body. There is a strong social element to having eczema and getting it under control.

One of the biggest challenges with eczema is managing your day-to-day life outside of the doctor’s office. How can patients learn to help themselves lead their most fulfilling life with the lowest disease burden?

Options for facing your eczema symptoms include^14,15:

Open communication is also very important. Ask your clinician as many questions as you can. Bring a family member or friend to doctor visits so that your support person can also be informed. Request as much follow-up as you need to get your questions answered. Remember, your caregivers are there because they want to help you. Working together with them is one of the most important aspects of your care!

References

Sangha AM. Dermatological conditions in skin of color: Managing atopic dermatitis. J Clin Aesthet Dermatol. 2021;14(3 suppl 1):S20-S22. www.ncbi.nlm.nih.gov/pmc/articles/PMC8211323/pdf/jcad_14_3_s1_s20.pdf
Free dictionary by Farlex. Quality of life. 2012. https://medical-dictionary.thefreedictionary.com/quality+of+life
Kaufman B, Alexis A. Eczema in skin of color: What you need to know. https://nationaleczema.org/eczema-in-skin-of-color/
American College of Allergy, Asthma & Immunology (ACAAI) and the Asthma & Allergy Network (AAN). Eczema in skin of color: Social and economic factors. https://eczemainskinofcolor.org/social-and-economic-factors/
Dupilumab (Dupixent^®). Prescribing Information. Regeneron Pharmaceuticals, Inc; 2024. https://www.regeneron.com/downloads/dupixent_fpi.pdf
Tralokinumab (Adbry^®). Prescribing Information. Leo Pharma A/S; 2023. https://www.leo-pharma.us/AdbryPI
Lebrikizumab-lbkz (EbgylssTM). Prescribing Information. Lilly USA; 2024. https://pi.lilly.com/us/ebglyss-uspi.pdf
Simpson, EL. et al. Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: Results from a phase 3, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2024:90:1190-1199.
Chu DK, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations. Ann Allergy Asthma Immunol. 2024;132:274-312.
Davis, DMR, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024;90:e43-e56.
Healthline. Targeted Treatments for Eczema: Everything You Need to Know. 4/13/22. https://www.healthline.com/health/eczema/biologics-for-eczema
Boguniewicz M, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: A multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5:1519-1531.
Sidbury R, et al. American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71:327-349.
Crane MW. Living well with eczema (and all the ways to do it). Available at: https://nationaleczema.org/how-to-live-well-eczema/
National Eczema Society. Living with eczema. 2023. https://eczema.org/information-and-advice/living-with-eczema/

Atopic Dermatitis

Atopic Dermatitis