Treating Severe Dermatitis: Options and Strategies
Severe dermatitis, or eczema, can be challenging to manage when dermatitis symptoms persist despite the use of creams and other topical treatments. For people with this level of skin inflammation, doctors often suggest additional therapies that work throughout the body to control symptoms. Below is a look at some common treatments for severe dermatitis.
Biologic Therapies
Biologic medications like dupilumab are often recommended as a first choice for treating severe dermatitis. These medicines work by targeting specific parts of the immune system responsible for causing inflammation in the skin. Dupilumab, for example, blocks proteins called IL-4 and IL-13, which play a key role in eczema flare-ups.
Dupilumab is given as an injection under the skin every two to four weeks. It can significantly reduce skin redness, itching, and the frequency of flare-ups. For many people, it is effective and has fewer side effects than older treatments like steroids. However, it may cause mild side effects, such as redness or soreness at the injection site and, less commonly, eye problems like conjunctivitis.
Janus Kinase (JAK) Inhibitors
Another newer option for severe dermatitis is JAK inhibitors like upadacitinib or abrocitinib. These oral medications help reduce skin inflammation by blocking signals that lead to itching, swelling, and redness. JAK inhibitors are often fast-acting, showing improvement in symptoms within a few weeks.
However, these medications carry a higher risk of serious side effects, including infections, heart problems, and blood clots. Because of this, doctors typically reserve them for people who haven’t responded well to other treatments or who need quick relief from severe flare-ups.
Systemic Immunosuppressants
For people who don’t respond well to biologics or JAK inhibitors, doctors may prescribe older drugs like cyclosporine, methotrexate, or mycophenolate mofetil. These medications suppress the immune system, reducing the body’s inflammatory response.
Cyclosporine is effective at calming down skin inflammation, but long-term use can lead to serious side effects, including kidney damage and high blood pressure.
Methotrexate is taken weekly and can be helpful for controlling severe eczema over time, but it may cause stomach upset, fatigue, and requires regular blood tests to check for liver or blood-related side effects.
While these medications can be effective, they tend to have more side effects compared to biologic treatments, so they are usually considered when other options haven’t worked.
Phototherapy
For people who prefer non-drug treatments, narrowband ultraviolet B (NBUVB) phototherapy can be an effective option. This treatment involves exposing the skin to controlled doses of UV light, which can reduce itching and redness. Phototherapy is usually done in a doctor’s office two or three times a week.
While phototherapy is generally safe, it requires regular visits to the clinic, which may not be convenient for everyone. Additionally, long-term use of UV light may slightly increase the risk of skin cancer, although this risk is considered low.
Conclusion
Severe dermatitis often requires a combination of treatments to keep symptoms under control. Biologic therapies like dupilumab or JAK inhibitors are often the first choice due to their effectiveness and relatively mild side effects. If these don’t work, systemic immunosuppressants like cyclosporine or methotrexate may be used, although they carry a higher risk of side effects. Phototherapy offers another option for those who prefer non-drug treatments. Your dermatologist will help decide the best treatment based on your specific symptoms and medical history.