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Treating Moderate to Severe Eczema


Lavanya Krishnan, MD

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Treating Eczema With Biologics

Biologics have been very successful in treating moderate to severe eczema cases. Learn more about how they work from an expert.
young man scratching skin on arm

Eczema is a very common skin condition seen frequently in the United States. The term “eczema” encompasses several subtypes of skin rashes, with the most common being atopic dermatitis. Atopic dermatitis is a chronic inflammatory skin condition often starting in early childhood. The disease is considered multifactorial, meaning it’s caused by a combination of genetic, environmental and immune-related factors. Most patients with atopic dermatitis experience itchy rashes with dry skin and high levels of IgE, or infection-fighting antibodies, in the blood.

Because eczema is multifaceted and can vary greatly in severity and symptoms experienced, a thorough understanding of treatment options is important.  

Caring for sensitive skin and eczema can be challenging, but with the right tips and tricks, you can give your skin the love it needs.

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Apr 28, 2017

2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

What Causes Moderate to Severe Eczema?

Dermatologists classify the condition based on the extent of skin affected by rashes and redness, as well as how intense the symptoms are. Redness, rashes, thickness and swelling can vary in severity, but patients with moderate to severe eczema will usually experience most or all of these reactions on the skin.

While we don’t know exactly what causes such severe reactions in the skin, many of the existing treatments for atopic dermatitis aim to treat dysregulation of the immune system, when the immune system produces too much inflammation in the body. They also aim to improve the skin’s ability to protect against the outside environment—strengthening the skin barrier—making it less susceptible to potential irritants from the outside.

Treatment Options for Moderate to Severe Atopic Dermatitis

Depending on the severity and nature of the condition, possible treatments include one or more of the following:

  • Over-the-counter moisturizers and topical or oral steroids

  • Oral antihistamines

  • Intramuscular steroid injections

  • Oral or topical antibiotics, antiviral medications, or antifungal medications

  • Topical non-steroidal anti-inflammatory drugs (NSAIDs)

  • Bleach baths

  • Phototherapy

  • Oral immune-modulating medications

  • Injectable immune-modulating medications (otherwise known as “biologics”)

Topical steroids are commonly prescribed for patients with moderate to severe atopic dermatitis. These medications are designed to calm down the immune dysregulation present in the affected skin. Use of topical steroids should be limited to areas where the rash is present. Skin on various parts of the body often varies in thickness, and this often dictates the strength of topical steroids that are prescribed. For areas with thin skin, such as the face and genital area, milder topical steroids or topical NSAIDs are usually prescribed. Oral steroids and intramuscular steroid injections can also be given based on the severity and extent of involvement of the rash.

Oral or topical antibiotics, antiviral medications and antifungal medications are also prescribed for patients with moderate to severe atopic dermatitis. When dealing with a compromised skin barrier, there is a higher chance for bacteria, viruses or fungi to cause a skin infection. Furthermore, scratching as a result of atopic dermatitis can cause skin infections due to frequent contact of the fingers to the skin. The infections cause further dysregulation of the immune cells, exacerbating the rash associated with atopic dermatitis.

There are also several systemic treatment options aimed at stabilizing the immune dysregulation in the skin. Phototherapy, the use of various wavelengths of ultraviolet (UV) light, is often recommended for patients with more widespread atopic dermatitis. Another option for patients with more severe disease is an oral medication that suppresses larger subsets of the immune system. These medications include cyclosporine (Neoral), methotrexate (Trexall), azathioprine (Imuran) and mycophenolate mofetil (CellCept).

THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.

Lavanya Krishnan, MD

Lavanya Krishnan, MD, is a board-certified cosmetic and general dermatologist currently practicing in San Francisco.
View her Healthgrades profile >

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© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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