top of page

Systemic treatments for Atopic Dermatitis/Eczema

Writer's picture: Andrew CollinsonAndrew Collinson

I find that the information regarding the latest and most promising systemic treatments can be a bit all over the place and as someone who has been through more than most I thought I would share some of these.





There is a lot of hope and excitement within the AD community due to the availability and pipeline of ground breaking medications. Jaks inhibitors and monoclonal antibodies in particular are providing the “cure” or at least a much more reasonable level of symptoms to many. I’m unfortunately one of the few in which these treatments initially have fairly miraculous effects but these have always worn off and by “worn off” I mean have gone off a cliff into a massive flair.


However, one benefit of this is I can give you a brief overview of what I’ve tried (and my experience) to see if they could be something you might want to consider requesting from your dermatologist. As a side note; if your dermatologist can’t prescribe them despite your symptoms meeting the criteria then get rid and find one that can.


Ciclosporin and Methotrexate


These are both pretty heavy medications which suppress your immune system entirely, they’re also used for people with organ transplants and as a cancer treatment. They require regular blood monitoring in particular to check the health of your liver and kidneys. This was largely all that was available for a long time if the topical creams didn’t control symptoms.


I took a ciclosporin tablet every day for a few years as a teenager and didn’t find it particularly helpful. Some people have better results with injections but I was never offered this. I took Methorexate injections once per week (the tablets made me feel queasy) for around 3 years in my mid 20’s and did find it to have a reasonable effect. However the potential side effects are significant and a high liver function blood test result made me stupidly try to come off of systemics entirely which I was very much punished for around a year later.


If your conditions are at the level that you require a systemic medication they will usually try you on one of these first however this practice concerns me. From my understanding the Jaks Inhibitors and monoclonal antibodies are far safer, with the latter not even necessarily requiring blood monitoring, so would this not be a better option? My primary concern being that patients are being tried on a less safe medication first as a cost saving exercise?


These arguably do have a better effect/potentially less side effects being injected. Obviously this can be daunting for some people, it certainly was for me. Also blood tests are my second least favourite thing in the world but unfortunately that’s followed by my first least favourite thing being having skin which is out of control. I do believe these get easier over time.


They also require refrigeration which can make things tricky when travelling, you’ll need a medication cool bag.


Dupilumab, Tralokinumab and Lebrikizumab


After my monster flair after a year off of Methotrexate I went back to St John’s institute of Dermatology at Guy’s Hospital London. This was when I was placed onto Dupilumab and initially experienced 6 months of being essentially symptom free.


Dupilumab was the first big breakthrough medication in dermatology approved by NICE for use in the NHS. After this failed I was put on Tralokinumab which again some people have very good results on. However this does take a long time to ramp up in your system, as in 6 months or so. I simply couldn’t wait that long on the chance that “it might” help and so I only lasted around 2 months before I was put on a Jaks inhibitor. 


All of the monoclonal antibody medications (or “mabs”) work in  a very similar way. To briefly summarise they inhibit specific protein/s which then block an immune system inflammation response, these proteins can change between each different type. The key difference with these medications are that they are highly targeted for our condition unlike the traditional immunosuppressants.


This makes them a great option for many and there are a lot of stories of people having excellent long term results. One side effect I experienced, which is fairly common, is dry and red eyes. When my eye symptoms first started I made the mistake of going to a local ophthalmologist who frankly didn’t have a clue and also didn’t trust what I was saying to him. However after visiting Mr Robbie at St Thomas Ikervis (essentially ciclosporin) eyedrops were prescribed and the symptoms disappeared and I have had no issues since.


These medications are administered through injection on various intervals. For example Dupilumab is every 2 weeks whereas Lebrakizumab goes down to once per month. They all seem to start with a “loading dose” where you get anywhere from 2-4 doses on day 1. The injections do also require refrigeration.


To offer some personal tips/advice while the thought of pre-filled syringes felt really daunting to me compared to the auto injector, I find the pre-filled syringes almost painless in comparison. It makes sense I suppose as the auto injection is being fired into your body whereas you can administer the pre-filled syringes much more slowly and controlled. However the first time self administering the pre-filled syringe was a real psychological hurdle. I would say do it very slowly and you’ll quickly see that the needle is so small that it barely hurts at all.



Abrocitnib and Upadacitinib



The Jaks inhibitors work by blocking Janus Kinase pathway which would otherwise then trigger inflammation (as a very basic overview).


A few benefits of these is that they tend to be fast acting, which is why I went from Tralokinumab to Abrocitnib. They are also taken in tablet form once per day so are much easier to travel with. They do require blood monitoring but are again more targeted than the immunosuppressants.


I started on Abrocitinib and then when this failed I was placed on Upadacitinib which was suggested as the “more potent” medication. However these both ultimately failed in the long term.


I have now started Lebrikizumab which will also be taken in conjunction with Methotrexate. Obviously very much not an ideal situation, in particular the Methotrexate, however anyone reading this with chronic AD will understand it’s a small price to pay if it helps.



I’ve really appreciated being given the opportunity to help some of you recently. As always, if you have any questions or I can help in any way please don’t hesitate to get in touch.

Recent Posts

See All

Comments


IMG_3780.HEIC

About Me

No one should have to suffer alone. Help me to create a community with support and resources so we can all help each other along the way. Join my mailing list to stay up-to-date with the latest news and information about everything related to life with a visible difference.

© 2021 by My Site. All rights reserved.

Join Our Mailing List

Thanks for subscribing!

  • LinkedIn
bottom of page