Newer Medications for Atopic Dermatitis

December 13, 2024 | Black & Kletz Allergy

Atopic dermatitis (i.e., eczema) is a chronic inflammatory disorder of the skin. The symptoms usually begin in infancy and early childhood, although less commonly, they may begin later in life.  Genetic predisposition is the underlying reason for most cases, however environmental factors and allergic sensitization to foods and aeroallergens may trigger and/or aggravate the condition.

The face and extensor regions of the extremities are usually affected in infants and young children, whereas the flexural areas, especially in the bends of elbows and knees, are more commonly involved in older children and adults.

The symptoms of atopic dermatitis may range from mild dryness and itching of the skin to moderate thickening and discoloration of the skin, excessive creasing and cracking of the skin, and oozing in severe cases.  It should be noted that inflamed skin is more susceptible to bacterial and fungal infections than skin that is not inflamed.  More and more body surface area is involved as the disease progresses and this can have a huge negative impact on one’s quality of life.

Though there is no cure for the genetic abnormalities that are responsible for atopic dermatitis at this time, many treatments are available to help reduce the ongoing inflammation and minimize the aggravating symptoms.  Until 2015, the only FDA-approved treatments for atopic dermatitis were topical corticosteroids and topical calcineurin inhibitors [e.g., Protopic (tacrolimus) ointment, Elidel (pimecrolimus) ointment].  Since then, many newer medications have been made available for the treatment of atopic dermatitis.

1. Eucrisa (i.e., crisaborole) topical ointment 2% – Approved by the FDA in December 2016 for mild-to-moderate atopic dermatitis in adults and children aged 2 years and older.  In March 2020, the FDA expanded the indication to include infants and children aged 3 months and older.
2. Dupixent (i.e., dupilumab) – A monoclonal antibody approved in 2017 for adults with moderate-to-severe atopic dermatitis which is not adequately controlled with topical prescription therapies.  It is the first biologic medication for atopic dermatitis and it is administered as a bi-weekly injection subcutaneously (SQ) or under the skin.  In 2019, this indication was expanded to include adolescents aged 12 years and older.  In 2020, it was further expanded to include children as young as 6 years of age.
3. Adbry (i.e., tralokinumab) – A monoclonal antibody that inhibits interleukin 13 (IL-13).  It was FDA-approved for the treatment of moderate-to-severe atopic dermatitis for adults whose disease is inadequately controlled with topical therapies.  In December 2023, the approval was expanded to include children 12-17 years of age.  This biologic is also given as a subcutaneous (SQ) injection every other week.
4. Rinvoq (i.e., upadacitinib)  – This oral JAK1-selective inhibitor was approved for the treatment of refractory moderate-to-severe atopic dermatitis in patients aged 12 years and older whose disease is not adequately controlled with other systemic drug products, including biologics.  It is taken daily in either 15mg. or 30mg. doses.
5. Cibinqo (i.e., abrocitinib) -An oral JAK1 inhibitor that is taken once a day that is indicated for the treatment for patients aged 12 years and older with moderate-to-severe atopic dermatitis.  It is dosed at 100mg. per day.
6. Opzelura (i.e., ruxolitinib) cream 1.5% – The first topical JAK inhibitor, which gained FDA approval, for short-term and non-continuous long-term treatment of mild-to-moderate atopic dermatitis in non-immunocompromised adults and adolescents whose disease is not adequately controlled with other topical prescription therapies.  It is applied twice daily to the affected areas of the skin.
7. Zoryve (i.e., roflumilast) topical cream – It got FDA approval for mild-to-moderate atopic dermatitis in adults and children aged 6 years and older in July 2024.  It is applied once a day to the affected areas as a 0.15% cream.
8. Ebglyss (i.e., lebrikizumab) – A monoclonal antibody that binds to IL-13 and inhibits the release of proinflammatory cytokines, chemokines, and IgE.  In September 2024, it was approved by the FDA for moderate-to-severe atopic dermatitis in patients aged 12 years and older who weigh at least 40 kg. (88 lbs.) in cases when the disease is not adequately controlled with topical prescription therapies.  It can be used with or without a topical corticosteroid.

Additional treatments:

1. In January 2015, the World Allergy Organization recommend the use of probiotics in pregnant and lactating women and their breastfed infants to prevent the development of atopic dermatitis.
2. Acyclovir, an anti-viral medication is effective in treatment of atopic dermatitis complicated by herpes virus infections (i.e., eczema herpeticum).
3. Excessive colonization of the affected skin by bacteria such as Staphylococcus and clinical infection in patients with atopic dermatitis can usually be controlled by antibiotics.
4. Phototherapy can be very effective in certain clinical scenarios of atopic dermatitis.
5. Immunosuppressive medications such as azathioprine, cyclosporine, mycophenolate, and methotrexate are effective in very severe cases of atopic dermatitis, but systemic toxicity limits their regular usage.
6. Antihistamines such as hydroxyzine may offer relief in individuals with atopic dermatitis from intense itching, but sedation is a common side effect.
7. Hydration of the skin with regular use of emollients such as Vaseline petroleum jelly can improve excessive dryness and itching in patients with atopic dermatitis.
8. A cool mist humidifier may help in reducing dryness in individuals with atopic dermatitis.
9. Soaps and detergents should be mild and non-irritating in patients with atopic dermatitis.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating atopic dermatitis for more than 50 years. We treat both adults and children.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from atopic dermatitis, other skin allergies and/or any other allergy symptoms, we are here to help lessen or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life.  Black & Kletz Allergy is devoted to providing the highest quality allergy care in a comfortable, considerate, and professional environment.