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"What are immunosuppressants and why are they used in eczema?  Immunosuppressants are powerful medicines that dampen down the activity of the body&amp;#039;s immune system.  They can be helpful for controlling severe eczema because they suppress the overactivity of the immune system that is causing the inflammation in the skin.  They are only used to treat very severe eczema that has not responded to treatment with more conventional treatments, such as topical steroids.  They are only prescribed by hospital specialists. What immunosuppressant medicines are used in eczema?  There are various immunosuppressant medicines that may be used if your eczema is so severe that more conventional medicines cannot control it. They may be given by injection or taken by mouth. Firstly, your doctor may try a short course of an oral corticosteroid, such as prednisolone, to control a severe flare-up. Alternatively, ciclosporin (Neoral) is licensed for short-term use in severe eczema, and azathioprine (eg Imuran) or mycophenolate (CellCept) may also be tried, though these are not licensed for eczema treatment. Not everyone responds to mycophenolate and it is recommended that this medicine is stopped if the eczema doesn&amp;#039;t respond within four to eight weeks. Are they suitable for everyone?  Obviously these powerful medicines are not necessary for everyone who has eczema and are only used for eczema that is severe and uncontrollable by other means.  Each medicine has its own list of contraindications (conditions in which the drug should not be used) and your specialist will check that it is safe for you to use before prescribing it.  The patient information leaflet provided with each medicine will tell you when it should not be used, and will also give other information relevant to that particular medicine. What do I need to be aware of while taking this kind of medicine?  Immunosuppressant medicines can increase your susceptibility to infections because your suppressed immune system is less able than normal to fight off bacteria, viruses and other foreign substances.  For this reason, you should consult your doctor immediately if you develop a sore throat, fever, any infections, including skin infections, or begin to feel generally unwell. If you are having long-term or intensive immunosuppressive treatment you may be at increased risk of developing lymphomas and other cancers, particularly skin cancer.  To reduce the risk of skin cancer you should minimise your exposure to strong sunlight and UV light by wearing protective clothing and using a sunscreen with a high protection factor.  Sun beds and UV light treatment such as PUVA should also be avoided. Discuss this with your doctor. Females should ensure they have had a cervical smear before starting these medicines. You should not eat grapefruit or drink grapefruit juice in the hour before taking a dose of ciclosporin as this can interfere with the medicine. Ciclosporin can occasionally increase potassium levels in your bloodstream. For this reason you should avoid consuming excessive amounts of foods that have high potassium content, for example dried fruit, bananas, tomatoes and &amp;#039;low sodium&amp;#039; salt, while you are taking the medicine.  You should also avoid potassium supplements. How will my treatment be monitored?  If you are prescribed ciclosporin your doctor will want you to have regular check-ups, not only to monitor the effect of the medicine on your eczema, but also to monitor for potential side-effects.  Your blood pressure will be monitored, and you will also need blood tests to monitor your blood count, kidney function, and liver function.  If you are prescribed azathioprine or mycophenolate you will also need to have regular check-ups to monitor the effect on your eczema.  The check-ups should also include blood tests to monitor the levels of blood cells in your blood since these medicines can cause your bone marrow to stop producing blood cells normally.  For this reason, you should consult your doctor immediately if you experience any infections, fever, or unexplained bruising or bleeding while taking them. What are the possible side-effects?  This depends on the particular immunosuppressant prescribed, but a full list of possible side-effects will feature in the patient information leaflet provided with the medicine. Remember that all medicines have side-effects, but this does not necessarily mean that you will experience any of them. The most common side-effects of ciclosporin are kidney problems, high blood pressure, tremor and increased hair growth.  The most common side-effects of mycophenolate are gastrointestinal upset, reduced numbers of white or red blood cells in the blood and increased infections.  The most common side-effects of azathioprine are increased infections, decreased production of blood cells by the bone marrow and gastrointestinal upset. Can I take them with other medicines?  Many medicines can interact with immunosuppressants, so it&amp;#039;s very important that you let your doctor know what medicines you are already taking or using, including prescription medicines, those bought without a prescription and herbal medicines, before you start treatment with an immunosuppressant. Likewise, once you have started the treatment, always check with your doctor or pharmacist before starting any new medicines. You should also be aware that vaccines may be less effective in people taking immunosuppressants.  This is because the dampened down immune system may not form adequate numbers of antibodies in response to a vaccine.  Live vaccines should be avoided because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; yellow fever and oral typhoid vaccines.  It&amp;#039;s important to discuss the need for alternative killed vaccines with your doctor. Ideally, you should have the influenza vaccine before starting treatment and annually thereafter. Also, ideally, the pneumococcal vaccine is recommended before starting treatment. Other people also read: Eczema: what is eczema? Seborrhoeic dermatitis: what are the symptoms? Topical steroids: why are they used?  Based on a text by Helen Marshall, pharmacist  Last updated 24.09.2014 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/skin-and-hair/a3665/immunosuppressants/>