For many people, eczema does not improve much after topical treatment with ointments or creams. In severe cases, oral immunosuppressants (eg., cyclosporine, azathioprine) or monoclonal antibody drugs can be used. Dupilumab is a monoclonal antibody approved to treat moderate to severe eczema, and is administered by subcutaneous injection every other week.
Systemic therapies often act on the immune system to ease eczema over large areas of the body. There are many systemic medications available on the market, including cyclosporine, mycophenolate, methotrexate, and azathioprine. Since these medications work on the entire body, they are far more effective than topicals but can also cause more side effects:
- Systemic medications can increase the chance of having an infection by suppressing the immune system.
- Cyclosporine can cause kidney damage and requires close monitoring. It should not be given continuously for more than two years.
- Azathioprine is relatively well tolerated, but prolonged use can cause liver and bone marrow toxicity.
These side effects can be minimized with proper use.
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