Emerging therapies for atopic dermatitis
Atopic dermatitis (AD) is the most common form of eczema. It is a chronic, inflammatory skin condition that typically causes dry, scaly patches; redness or other skin discoloration; and intense itching.
More than a simple rash, AD is a lifelong condition that involves systemic inflammation, an impaired skin barrier, and underlying immune system dysfunction.
Diligent skin care and avoidance of AD triggers have always been — and continue to be — major aspects of managing the condition. When further treatment is necessary, doctors consider a variety of medications and procedures.
In the past, steroids and immunosuppressants were mainstays of AD treatment. Now, new and emerging options offer targeted therapy that may better manage symptoms without the use of steroids.
This article takes a look at the latest advances in AD treatment.
AD is a complex skin condition and can affect each person differently. Multiple factors,
Because AD does not have one specific known cause, treatment has traditionally
While these options remain effective for many people, they can lead to significant side effects, may become less effective over time, and rely on reducing inflammation in general rather than targeting specific immune pathways in AD.
For these reasons, symptoms tend to return quickly when a person stops using these medications, and many people find that these drugs do not effectively manage their symptoms in the long term.
Emerging therapies aim to target specific underlying causes of AD. They can allow people to manage inflammation without the use of steroids and may be safer and more effective for long-term use, even in children.
People can use nonsteroidal topical creams to manage inflammation. Because these products do not contain steroids, they are less likely to cause skin thinning and are safer for sensitive areas of the body, such as the face.
The newest nonsteroidal topical creams are roflumilast (Zoryve) and tapinarof (Vtama).
Roflumilast works by blocking phosphodiesterase-4 (PDE-4), an enzyme in immune cells that strengthens inflammatory signaling.
Tapinarof
Janus kinase (JAK) is an enzyme that acts as a messenger between cells and the immune system. Many inflammatory molecules in the body that are responsible for itch and inflammation use JAK to transmit their signals.
Because multiple inflammatory molecules communicate via JAK, blocking this enzyme can suppress several inflammatory pathways at once, providing faster and more complete symptom relief for many people.
Doctors can prescribe JAK inhibitors in topical or oral form, depending on the severity of AD.
The currently available topical JAK inhibitors for AD are ruxolitinib (Opzelura) and delgocitinib (Anzupgo). The available oral options are upadacitinib (Rinvoq) and abrocitinib (Cibinqo).
Biologics are medications made using biological components such as cell parts, proteins, or DNA. They target specific aspects of immune dysfunction rather than the entire immune system.
To treat AD, biologics target cytokines, which are molecules that drive inflammation, skin barrier disruption, and itching.
Biologics for AD treatment come in injectable form, and a person can inject a dose once or twice per month.
In people with AD, the skin microbiome often becomes imbalanced, a condition known as dysbiosis. This imbalance can lead to an overgrowth of harmful microbes and contribute to skin sensitivity and inflammation.
Bacteriotherapy involves the topical application of beneficial bacterial products to help restore the skin microbiome. The goal is to improve skin health in the long term to reduce the severity of eczema flares.
In
OX40 and OX40L are protein markers on immune cells that bind together and keep inflammatory responses active. OX40 is present on T cells, and OX40L is found on other immune cells called antigen-presenting cells.
Researchers are currently studying OX40/OX40L inhibitors as a treatment for AD. These drugs work by blocking the interaction between OX40 on T cells and OX40L on partner immune cells.
When OX40 and OX40L cannot connect, the inflammatory process driving AD calms down.
Not everyone needs to add the latest innovations to their eczema treatment plan. If a person’s AD is well managed, doctors may continue to recommend skin care, trigger avoidance, and current medications.
All AD treatments have some possible side effects. While newer treatments are generally safe, some can cause mild reactions such as skin irritation, eye redness, and a slightly higher risk of infection.
The side effects of these newer treatments are usually less severe and easier to manage than the possible side effects of long-term steroid and immunosuppressant use.
However, some treatments, such as JAK inhibitors, can cause severe negative reactions. JAK inhibitors carry a boxed warning from the FDA about an increased risk of serious heart-related complications.
Before starting any new AD treatment, a person should speak with a doctor about possible side effects and any individual risk factors.
There is never a wrong time to start a conversation about new and emerging AD treatments. Even if a person’s eczema is well managed, newer options may offer safer and more customized care.
Treating atopic dermatitis (AD) has traditionally involved the use of broad-spectrum steroids and immunosuppressants to reduce inflammation. While those therapies are still a part of AD management for many people, new and emerging treatments may offer safer, more targeted options.
Biologics, JAK inhibitors, nonsteroidal topicals, and skin probiotics are among the recent advances in AD treatment. Some are already available, while others, such as OX40/OX40L inhibitors, are currently the subject of research.