What Are Immunosuppressants?
In people with atopic dermatitis (eczema), there is a dysfunction in the immune system, which results in an overactive, inflammatory state. Because of this dysfunction in the immune system, treatment with immunosuppressants may be appropriate for individuals with severe atopic dermatitis. Immunosuppressants suppress or interfere with the immune system response and may indirectly improve the function of the skin barrier and reduce symptoms, including itching, redness, and rash.
How do immunosuppressants treat atopic dermatitis?
Immunosuppressants are a systemic treatment, meaning they work on the whole body and not just one particular area as topical treatments do. Systemic treatments like immunosuppressants do not rule out the need for topical treatments, especially good skincare. Good skin care, including the frequent use of moisturizers, is always a necessary component in the treatment of atopic dermatitis. The American Academy of Dermatology states that immunosuppressants are recommended for adult and pediatric patients whose disease is not controlled through the use of emollients, topical therapies, and/or phototherapy, as well as those patients whose medical, physical, or psychological states are greatly affected by their skin disease.1,2
There are a couple different off-label medications used in the treatment of atopic dermatitis that are classified as immunosuppressants, including:
Azathioprine inhibits the production of T-cells and B-cells (another type of white blood cell) and reduces the inflammatory response. Azathioprine is effective in improving the skin symptoms of atopic dermatitis, reducing itching and sleep loss. Marketed as Imuran® (azathioprine), azathioprine may cause serious side effects, including gastrointestinal disturbances (such as nausea, vomiting, and bloating), liver dysfunction, and leukopenia (a reduction in the number of white blood cells that can increase the danger of infections).1,2
These are not all the possible side effects of Imuran®. Patients should talk to their doctor about what to expect with treatment with Imuran®.
Cyclosporine inhibits the activation of T-cells, the white blood cells involved in the immune system's inflammatory response. Cyclosporine, marketed as Sandimmune® (cyclosporine), has proven to have beneficial effects on atopic dermatitis lesions and itching. In most patients, short-term cyclosporine therapy is effective and can be repeated in those with recurrent flare-ups. Potential side effects of cyclosporine include infections, kidney toxicity, high blood pressure, tremor, headache, abnormal hair growth, increased growth of the gums in the mouth, and an increased risk of skin cancer and lymphoma.1,2
These are not all the possible side effects of Sandimmune®. Patients should talk to their doctor about what to expect with treatment with Sandimmune®.
Methotrexate is an analog of folic acid that blocks the synthesis of DNA and RNA. Methotrexate is also believed to affect T-cell function negatively, and it is used to treat several inflammatory diseases and types of cancer. Methotrexate has been shown to be effective in treating the itch and reducing the severity of atopic dermatitis. Side effects may include nausea and other gastrointestinal symptoms (when given orally) and serious side effects, such as the suppression of bone marrow (a decrease in the production of blood cells), liver toxicity, and pulmonary fibrosis (scarring of the lungs), can occur.1,2
These are not all the possible side effects of methotrexate. Patients should talk to their doctor about what to expect with treatment with methotrexate.
Mycophenolate mofetil (MMF) is an immunosuppressant that selectively affects B-cells and T-cells, giving this medication a unique way to treat inflammatory disorders. It is marketed as CellCept® (mycophenolate mofetil). Results from clinical trials are mixed, but MMF may be helpful as an alternative therapy for severe atopic dermatitis that does not respond to other treatments. Side effects may include nausea, fatigue, flu-like symptoms, liver enzyme abnormalities, and infections, such as herpes zoster, herpes simplex, and Staphylococcal infection.1,2
These are not all the possible side effects of CellCept®. Patients should talk to their doctor about what to expect with treatment with CellCept®.
Before using immunosuppressants
Because immunosuppressants affect the entire body, individuals must receive a clinical and laboratory workup to ensure they do not have active, infectious diseases, including hepatitis B and C or HIV infection. In addition, organ function tests may be needed before and during therapy with certain drugs.1