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Eczema Off-label Treatments

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Age
Eczema Severity Level
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Featured Off-label Treatments
Other Off-label Treatments
  • Methotrexate
    Methotrexate (Methotrexate)
    Who is this for?:
    If you have severe eczema that affects a large part of your body and doesn't respond well to steroids
    None
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    High
    Cost:
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    Delivery:
    Oral or injection daily
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    KEY TAKEAWAYS
    Methotrexate is slower to work but can be effective for long-term control of atopic dermatitis. It typically takes at least 6 weeks to see effects. The medication works by decreasing inflammation through inhibiting cell division and lymphocyte proliferation.
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    Common side effects include nausea, vomiting, diarrhea, and fatigue. More serious but rare side effects include liver toxicity and low blood counts, which requires regular blood test monitoring. Taking folic acid supplements helps reduce these side effects.
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    When compared to other treatments, methotrexate shows lower effectiveness than cyclosporine and dupilumab in the short term (8 weeks), but may have better long-term outcomes. In children, methotrexate shows better drug survival rates than cyclosporine but lower than dupilumab.
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    The medication can be used as a maintenance therapy for longer-term control of atopic dermatitis, unlike cyclosporine which is typically limited to one year of use due to side effects.
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  • Olumiant
    Olumiant (Baricitinib)
    Who is this for?:
    If you need strong and fast relieve and treatments applied to the skin are not sufficient or appropriate
    If your child is over 2 years old, needs strong and fast relieve, and treatments applied to the skin are not sufficient or appropriate
    Effectiveness:
    Side Effects:
    Medium
    Cost:
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    Delivery:
    Oral once daily
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    KEY TAKEAWAYS
    Baricitinib 4mg combined with topical corticosteroids (TCS) is effective for treating moderate-to-severe atopic dermatitis, with about 31% of patients achieving clear or almost clear skin after 16 weeks of treatment. The medication starts working quickly, with improvements in itch seen as early as 2-4 days after starting treatment.
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    The benefits of baricitinib can be maintained long-term (up to 52-68 weeks) in patients who respond to treatment. Some patients can even reduce their dose while maintaining benefits, though others may need to continue the original dose.
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    Common side effects include nasopharyngitis (common cold), herpes simplex infections, upper respiratory infections, and headache. While the medication is generally well-tolerated, patients need to be monitored for infections and other potential side effects.
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    In real-world clinical practice, about 43% of patients may discontinue treatment due to lack of effectiveness or side effects. However, the medication can be effective even in patients who didn't respond to other treatments like dupilumab.
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  • Imuran
    Imuran (Azathioprine)
    Who is this for?:
    If you have severe eczema but can wait 2-3 months for a response
    None
    Effectiveness:
    Side Effects:
    High
    Cost:
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    Delivery:
    Oral daily
    See Evidence
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    KEY TAKEAWAYS
    Azathioprine has shown lower effectiveness compared to newer treatments like dupilumab and high-dose cyclosporine for treating moderate-to-severe atopic dermatitis.
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    Azathioprine has a slow onset of action (taking weeks to months to work) and requires regular blood test monitoring due to potential side effects on bone marrow and liver.
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    Common side effects include stomach upset, increased risk of infections and cancers, bone marrow suppression, liver toxicity, and rare allergic reactions. Due to these risks, recent medical guidelines recommend against using azathioprine for atopic dermatitis.
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    Treatment discontinuation rates are high with azathioprine, mainly due to side effects and lack of effectiveness. Studies show it has a higher rate of discontinuation compared to other treatments like dupilumab.
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