I f you’re living with severe eczema, you know that when the condition flares up, you need a medication that can calm the itchy, painful rash — and you need it immediately.
Oral and topical steroids can quickly reduce itching by helping to ease the condition’s underlying inflammation — but they can’t be used for extended periods due to potential side effects. In the past, that has left people who have severe eczema with relatively few options for successfully and safely treating their condition over the long term.
Thankfully, though, this is starting to change, as new prescription medications have recently become available, says the National Eczema Association (NEA). In 2017, the Food and Drug Administration (FDA) cleared the first biologic for severe eczema and followed that up in 2022 with the approval of a new class of drugs called Janus kinase (JAK) inhibitors.
Before you ask your doctor about JAK inhibitors, you’ll need to do your homework — and make sure these drugs are right for you. Find out more about how this new treatment can potentially help you better manage your symptoms day to day.
How Severe Eczema Is Treated
Eczema is actually a group of chronic, inflammatory conditions that cause your skin to become itchy and inflamed or have a rash-like appearance, according to the NEA. There are seven types of eczema, with atopic dermatitis being the most common, the association says.
If you’ve been living with severe eczema, you know that, when it flares, you develop “red, flaky patches that can occur throughout the body,” notes Marisa Garshick, MD, an assistant clinical professor of dermatology at Weill Cornell Medical Center and a dermatologist at MDCS Dermatology in New York City. “Severe eczema tends to be when the patches are thicker or more widespread or involve certain areas that can make it disruptive to quality of life.”
If your itchiness is relentless, though, the NEA says it’s likely you have a severe form of the condition, regardless of where the patches are on your body.
Currently, the available treatments for eczema — including oral medications, topical medications, and light therapy — each work in different ways to manage the condition and its symptoms. Here’s a closer look.
Topical and oral steroids are frequently prescribed to treat the dry, itchy skin associated with eczema. But long-term use of these drugs, considered immunosuppressants, isn’t recommended, due to significant side effects ranging from skin thinning and stretch marks to weight gain, high blood pressure, and gastrointestinal (GI) problems.
Immunosuppressants such as azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil are systemic drugs. As their name suggests, they’re designed to suppress the immune system in order to control the symptoms of eczema.
It’s believed that an overreacting immune system causes the inflammation behind symptoms such as itching, irritation, and skin problems, according to the NEA.
These immunosuppressants can also cause long-term side effects, including increased risk of infection, nausea and vomiting, and increased risk of certain types of cancers. As a result, they are generally recommended for short-term use to get eczema under control. If the treatment is effective, your dermatologist may gradually reduce your dose and then recommend switching to topical medications for long-term management.
Light therapy, also called phototherapy, uses different wavelengths of ultraviolet (UV) light to quell the inflammation that can lead to eczema outbreaks, according to the American Academy of Dermatology. For this treatment, people stand in front of a light-emitting machine that is activated for a few seconds or minutes.
How JAK Inhibitors Work for Severe Eczema
JAK inhibitors work by targeting JAK enzymes, which transmit signals from the immune system throughout the body via the JAK-STAT (signal transducer and activators of transcription) pathway and cause eczema-related inflammation, according to the NEA.
Research suggests that JAK enzymes play a role in driving the abnormal immune responses behind several complex autoimmune conditions, including eczema, by stimulating the production of inflammatory proteins called cytokines. JAK inhibitors are designed to disrupt the overactive JAK pathways seen in eczema and to limit the cytokines that cause inflammation, in turn curbing its symptoms.
Although four JAK inhibitors have been evaluated for use in eczema, only three — upadacitinib (sold under the brand name Rinvoq), ruxolitinib (sold under the brand name?Opzelura), and abrocitinib (sold under the brand name Cibinqo) — have received FDA approval for the condition. Another JAK inhibitor,?baricitinib, is currently in clinical trials and has been approved to treat other conditions.
8 Essential Facts About JAK Inhibitors for Severe Eczema
1. JAK inhibitors have helped change the treatment landscape for eczema.
Historically, “severe eczema is something that we only really had a few treatments for, and it was really limited to topical steroids or oral immunosuppressants,” Dr. Garshick says. With JAK inhibitors, “we’re able to reduce the inflammation in terms of the skin and the itching without necessarily turning off the whole immune system. And so we’re hopeful that these newer medications become easier to tolerate.”
2. You may see faster results with JAK inhibitors.
Oral and topical steroids and other immunosuppressants offer quick relief of severe symptoms, which is why they are often prescribed for eczema — at least for short-term use. While biologics may be safer than immunosuppressants for long-term use, they also take longer to start working. One of the potential advantages of JAK inhibitors is that they may start helping to relieve your symptoms in as little as three days, with significant results in four weeks, the NEA says.
3. JAK inhibitors may be safer than immunosuppressants and steroids for long-term use.
Although some treatments, like steroids, work quickly, they’re also associated with potentially harmful side effects. As a result, they’re generally not prescribed for more than a month, according to the NEA. That’s why some people may opt for alternatives such as JAK inhibitors, which can be used continuously to manage the condition.
4. JAK inhibitors still have side effects.
Like all medications, JAK inhibitors have side effects, but given their record as treatments for other diseases, such as rheumatoid arthritis (RA), they are generally thought to be safe even after years of use, the NEA notes.
That said, there are some things to consider if your dermatologist prescribes a JAK inhibitor for you. Some potential side effects including an increased risk of:
- Infection, particularly tuberculosis
- Cancer, including lymphoma, and immune system problems
- Blood-clotting problems such as deep vein thrombosis, pulmonary embolism, and arterial thrombosis
- Tears in the stomach or intestines
5. JAK inhibitors and biologics are not the same.
JAK inhibitors are often compared to biologics, as they both offer targeted treatment for eczema (meaning, they target specific areas of the immune system, as opposed to the entire immune system). JAK inhibitors target different pathways in the body than biologics, though.
6. JAK inhibitors are available in topical and pill form.
JAK inhibitors can be swallowed as a pill or applied to the skin in a topical form. In contrast, biologics are either injected or given by infusion in intervals ranging from weekly to monthly.
7. Not all insurance plans cover JAK inhibitors — at least as a first treatment.
More established prescription treatments, such as topical steroids, are usually paid for by insurance, but coverage for newer treatment options can vary by carrier, and some may require that you try other treatments before starting a newer one such as a JAK inhibitor, Garshick says. “The hope is that the more [treatments] that are available, the greater the likelihood of hopefully getting an option for each insurance plan and for each person who really needs it,” she adds.
8. JAK inhibitors can be expensive, but there is financial assistance available.
Even with insurance coverage, JAK inhibitors may come with significant out-of-pocket costs. Talk to your insurance company about your options. Your doctor may also be able to point you to patient assistance programs or other financial options to help lower the cost. You can also visit the Medicine Assistance Tool, a search engine for drug assistance programs you can research.
Is It Time to Try a JAK Inhibitor?
7 FAQs About Treating Severe Eczema With JAK Inhibitors, Answered
Are JAK Inhibitors Right for My Eczema?
Next Steps: Making Treatment Decisions
You’ve learned a lot about treatment options for eczema. So what’s next?
Take some time to absorb all of this info and talk with your dermatologist to determine the best approach for you. Here are some things to consider.
Before your next appointment, think about your current treatment plan and how well it’s controlling your symptoms.
- Are you satisfied with your current treatment?
- Have your eczema symptoms improved as well as you had hoped?
- Are you downplaying your symptoms to your doctor?
- Are your symptoms interfering with your quality of life (sleep or self-image, for example)?
- Are you able to follow your treatment regimen as prescribed?
- Have you tried other treatments to see if they help you manage your symptoms?
If you’re having trouble finding a treatment plan that works for you, you might want to talk to your dermatologist. Here are a few conversation starters that you can use at your next appointment.
- Do you think it’s possible for me to gain better control of my eczema?
- What else can I do to better manage my symptoms?
- How often should I be using my treatments?
- What should I do during flares?
- What should my maintenance plan look like?
- What can I do to maximize the effectiveness of my medication?
- Are there certain fabrics or products I should avoid?
- What should I do if I don’t see an improvement in my symptoms?
- Am I a good candidate for a JAK inhibitor?
- How often should I come in for checkups?