Several oral and injectable medications have also been approved to help manage atopic dermatitis symptoms such as itching.
Biologics
Biologics target specific parts of the immune system that contribute to inflammatory diseases such as atopic dermatitis.
[3]
Two biologic drugs have been approved by the FDA to treat atopic dermatitis. Both are injected subcutaneously (through the skin), and can be self-administered.
Dupilumab (Dupixent) is approved to treat adults and children 6 months old and older with moderate to severe atopic dermatitis that hasn’t responded well to topical medications. Dupilumab works by blocking the activity of certain inflammatory chemicals in the body.
The common side effects of dupilumab are generally mild, and they include:
[10]
- Eyelid and eye inflammation
- Injection site reactions
- Cold sores
Tralokinumab-ldrm (Adbry) is approved to treat people 12 years old and older with moderate to severe atopic dermatitis that hasn’t responded well to topical medications. It works by blocking a protein that plays a role in the body’s immune response that leads to inflammation of the skin.
[11]
The most common side effects of Adbry include:
[12]
- Upper respiratory tract infections
- Eye and eyelid inflammation
- Reaction at the injection site
- High eosinophil count (a type of white blood cell)
Lebrikizumab-lbkz (Ebglyss) was approved by the FDA in September 2024 for the treatment of atopic dermatitis in adults and children ages 12 and older.
[13]
Ebglyss works by minimizing eczema-related inflammation in the body that can result in dry, itchy and irritated skin. The most common side effects of Ebglyss are eye and eyelid inflammation (including redness, swelling, and itching), reactions at the injection site, and shingles (herpes zoster).
Nemolizumab (Nemluvio) was approved in December 2024 by the FDA to treat moderate to severe atopic dermatitis in combination with topical corticosteroids or calcineurin inhibitors in patients ages 12 or older. This treatment is intended for people whose atopic dermatitis has not adequately improved with topical prescription treatments.
Nemluvio works by targeting a protein in the body that leads to itch and inflammation in atopic dermatitis. The most common side effects of Nemluvio in people with eczema include:
[14]
- Headache
- Hives
- Joint pain
- Muscle aches
Systemic Immunosuppressants
In moderate to severe cases of atopic dermatitis, doctors may prescribe a systemic immunosuppressant, such as cyclosporine (Neoral or Sandimmune), azathioprine, methotrexate (Trexall or Rasuvo), or mycophenolate mofetil (CellCept).
[3]
These drugs help control or suppress the immune system to stop the itch-scratch cycle and allow the skin to heal.
When prescribed for atopic dermatitis, immunosuppressants are considered “off-label” because they are not approved by the FDA for this use.
These drugs can have potentially serious side effects, such as an increased risk of developing dangerous infections and cancers, and are not recommended for long-term use.
Oral JAK Inhibitors
JAK inhibitors are a relatively new class of oral immunomodulators that can block immune system signals and thereby reduce inflammation and itch.
The FDA has approved two oral JAK inhibitors, upadacitinib (Rinvoq) and abrocitinib (Cibinqo), to treat moderate to severe atopic dermatitis.
[3]
Rinvoq and Cibinqo are not recommended for use in combination with other JAK inhibitors, biologics, or other immunosuppressants. The FDA has placed a box warning on these medications for potentially increasing the risk of all-cause mortality, serious infections, certain cancers (including lymphoma), heart attack, stroke, and thrombosis (blood clots).
