Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate. Dupilumab is a new medication that improves eczema lesions, especially moderate to severe eczema. Dupilumab, a monoclonal antibody, suppresses inflammation by targeting the interleukin-4 receptor. Others
In September 2021, ruxolitinib cream (Opzelura) was approved by the U.S. Food and Drug Administration (FDA) for the topical treatment of mild to moderate atopic dermatitis. It is a topical Janus kinase inhibitor. Light therapy
Narrowband UVB
Atopic dermatitis (AD) may be treated with narrowband UVB, which increases 25-hydroxyvitamin D3 in persons in individuals with AD.Light therapy using heliotherapy, balneophototherapy, psoralen plus UVA (PUVA), light has tentative support but the quality of the evidence is not very good compared with narrowband UVB, and UVA1. However, UVB is more effective than UVA1 for treatment of atopical dermatitis.Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer. Alternative medicine
Topical
Limited evidence suggests that acupuncture may reduce itching in those affected by atopic dermatitis.Chiropractic spinal manipulation lacks evidence to support its use for dermatitis. There is little evidence supporting the use of psychological treatments. While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice. Supplements
Sulfur: There is currently no scientific evidence for the claim that sulfur treatment relieves eczema. Chinese herbs: It is unclear whether Chinese herbs help or harm. Dietary supplements are commonly used by people with eczema. Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.
Environmental
The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment in childhood which leads to an insufficient human microbiota. It is supported by epidemiologic studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases the risk for asthma and allergy. One systematic review of literature on eczema found that urban areas have an increased prevalence of eczema compared to rural areas. While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration. Malnutrition
Essential fatty acid deficiency results in a dermatitis similar to that seen in zinc or biotin deficiency. Genetic
A number of genes have been associated with eczema, one of which is filaggrin. Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.Eczema occurs about three times more frequently in individuals with celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the conditions. Prevention
Exclusive breastfeeding of infants during at least the first few months may decrease the risk. There is no good evidence that a mothers diet during pregnancy or breastfeeding affects the risk, nor is there evidence that delayed introduction of certain foods is useful.