Immunosuppressants to Treat Eczema
Reviewed by: HU Medical Review Board | Last reviewed: April 2023 | Last updated: May 2023
Atopic dermatitis, or eczema, treatment begins with topical medicines. These creams and ointments are applied to the skin to control symptoms.1
When topical treatments are not enough to control symptoms, your doctor may recommend an immunosuppressant drug. These drugs typically are used for people with moderate to severe eczema. They also may be used when eczema greatly interferes with your daily life.2
How do immunosuppressant drugs work?
The immune system is a complex system of biological pathways. A biological pathway is a series of actions and signals that happen in the body. The immune system uses many of these pathways to respond to perceived health threats. This process is what leads to eczema symptoms.3
Immunosuppressants are systemic drugs. This means they travel through your bloodstream. They work by making the immune system less responsive (suppressing it). This can relieve the symptoms of eczema.4
Different immunosuppressants are used for treating eczema, including systemic steroids and other drugs.4
Cyclosporine suppresses certain immune cells and proteins involved in the inflammatory immune response. It targets T cells and interleukin-2 (IL-2). T cells are a type of white blood cell that fight infection and cause inflammation in eczema. IL-2 is a protein made by T cells.1,5,6
Cyclosporine was developed to help people receiving organ transplants. When it is prescribed for eczema, it is an “off-label” use. This means it has been approved by the US Food and Drug Administration (FDA) to treat other conditions but not eczema.4
Still, cyclosporine is safe to use. Clinical trials show it can reduce the severity of eczema. However, it should only be used for short periods of time because it suppresses the immune system and therefore the body’s ability to fight infection. Most adults or children will use it only for 3 to 6 months. Experts do not recommend using cyclosporine for eczema for longer than 1 year.2,4,7
Cyclosporine can be taken orally or given as an injection under the skin. Children should receive the injectable form only.2,4,7
Methotrexate suppresses T cells by interfering with DNA synthesis. It is approved to treat certain cancers and inflammatory disorders. It is also approved to treat a skin condition called psoriasis. Its use for eczema is considered off-label. Methotrexate is used when other topical and systemic treatments have failed.2
Clinical trials show that methotrexate can improve eczema symptoms. It can be taken as a tablet or as an injection under the skin. It has proved safe in children taking it for psoriasis. But it is not well studied in children with eczema.2
Azathioprine slows or blocks the development of T cells and B cells by blocking purine synthesis. Purines are the building blocks of DNA. While other cells have ways around this interference, T cells and B cells do not.2,7,8
B cells are a kind of immune cell that makes antibodies. Antibodies are immune proteins that identify infections. Azathioprine may be used if either cyclosporine or methotrexate did not work.2,7,8
This is another drug that was developed to prevent the immune system from rejecting a transplanted organ. It is approved for use in people who have had kidney transplants and those with rheumatoid arthritis. Its use for treating eczema is off-label.2
Azathioprine is considered safe to use. Clinical trials show it is effective in reducing the symptoms of eczema. It comes as a tablet and can be taken by children and adults.2
Mycophenolate mofetil suppresses T cells and B cells by interfering with purine synthesis. This drug may be used if cyclosporine or methotrexate did not work.2,7,9
Results from clinical studies about mycophenolate mofetil are mixed. But overall, they show that it can help some people with eczema. It has been used safely in adults and children ages 2 and older.2
Your body naturally makes steroids to manage your immune system and stress level. Steroids suppress the immune system. Taking systemic steroids may be recommended in some situations, but it is generally discouraged for treating eczema.2
This is because once these drugs are stopped, symptoms may return but be more severe. This is called a rebound flare.2
Systemic steroids typically are used for only a short time. They may also be used to bridge from one therapy to another.2
What are the possible side effects?
Side effects can vary depending on the specific drug you are taking.
People with eczema have problems with their skin barrier. This puts them at increased risk of infection from bacteria, viruses, and fungi. Using an immunosuppressant drug also increases the risk of developing an infection. This is because the drug reduces the immune system’s response.7
Taking immunosuppressant drugs also may lead to potentially serious side effects such as:2,4
- Increased risk of developing certain types of cancers
- Increased blood pressure (cyclosporine)
- Increased risk of kidney damage (cyclosporine and methotrexate)
- Risk of liver damage (methotrexate)
- Upset stomach and/or vomiting
Methotrexate has a boxed warning, the strictest warning from the FDA. It has this warning because it can cause serious side effects and problems, including severe allergic reaction and death. It also causes severe fetal abnormalities (birth defects) in people who are pregnant.10
These are not all the possible side effects of immunosuppressants. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking an immunosuppressant.
Other things to know
If you have tried topical treatments and they are not working for you, your doctor may recommend an immunosuppressant. Ask your doctor how the risk of increased infection might affect you. Talk to your doctor about other possible side effects as well.
Also consider whether you need to be under the care of a specialist such as a doctor who has special training in skin conditions (dermatologist). Many people with eczema are first treated by a family doctor. But if your doctor recommends immunosuppressant drugs, it may be time to find a dermatologist or allergist you trust.7
Before beginning treatment for eczema, tell your doctor about all your health conditions, allergies, and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.