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What Are Immunosuppressants?

In people with atopic dermatitis (AD), also known as atopic dermatitis, 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 AD. Immunosuppressants suppress or interfere with the immune system response and may indirectly improve the function of the skin barrier and reduce the symptoms of AD, including itching, redness, and rash.

Immunosuppressants are a systemic treatment, meaning they work on the whole body and not just one particular area like topical treatments do. Systemic treatments like immunosuppressants do not rule out the need for topical treatments, especially good skin care. Good skin care, including the frequent use of moisturizers, is always a necessary component in the treatment of AD. 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

Types of immunosuppressants

There are a couple different medications used in the treatment of AD that are classified as immunosuppressants, including:

Azathioprine

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 AD, reducing itching and sleep loss, and decreasing the bacteria Staphylococcus, which is frequently found in large numbers on the skin of people with AD. 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

Cyclosporine

Cyclosporine inhibits the activation of T-cells, the white blood cells that are involved in the inflammatory response of the immune system. Cyclosporine, marketed as Sandimmune® (cyclosporine), has proven to have beneficial effects on AD lesions and itching. In most patients, a short-term therapy of cyclosporine 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

Methotrexate

Methotrexate is an analog of folic acid that blocks the synthesis of DNA and RNA. Methotrexate is also believed to negatively affect T-cell function, and it is used to treat several inflammatory diseases and types of cancer. Methotrexate has been shown to be effective in treating the itching and reducing the severity of AD. 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

Mycophenolate mofetil

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 AD 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

Before using immunosuppressants

Because immunosuppressants affect the entire body, individuals must receive a clinical and laboratory work-up 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

Emily Downward | June 2017
  1. Simon D, Bieber T. Systemic therapy for atopic dermatitis. Allergy. 2014;69:46-55.
  2. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71:327-49.