New hope, new treatments for eczema

Professor Andrew Wright* explores the exciting potential of new treatments in the pipeline for treating eczema.

Over the past five years we have seen exciting developments in eczema treatments, with many other promising options on the horizon. Some of these newer treatments are becoming standard practice in NHS care, signalling a significant shift in how moderate-to-severe eczema is managed. These treatments have the potential to help people with more challenging eczema and really improve quality of life. With new advancements emerging rapidly, it’s an ideal time to review these innovations.

While this article doesn’t cover every new treatment, it highlights key areas where advancements are making a difference. The pace of progress is so swift that by the time you read this, even more options might be available!

Biologic treatments

Some of the most effective newer treatments belong to the group of antibody therapies known as biological checkpoint inhibitors (‘biologics’). These target inflammation by acting on interleukins in the skin and are often referred to as monoclonal antibodies (MABs). Notable treatments from this group include dupilumab, tralokinumab and lebrikizumab – all approved for use by the NHS, with nemolizumab currently being assessed. The OX40 antagonist monoclonal antibody treatment telazorlimab has completed Phase 2 clinical trials. These drugs are showing great promise in treating various aspects of atopic eczema. They are typically administered via injection at varying intervals.

JAK inhibitors

Another powerful group of medicines targeting the inflammatory pathway is the Janus Kinase Inhibitors (JAK Inhibitors), recognizable by the letters ‘nib’ in their names. These treatments are available in both tablet and cream forms. JAK inhibitors have a broader impact on the immune system compared to monoclonal antibodies, which means they may have more side effects.

Second-generation inhibitors like abrocitinib and upadacitinib have now been approved for use by the NHS. Other JAK inhibitor treatments are expected to be launched soon. Some, like ruxolitinib are already available as a cream for treating mild to moderate eczema. Cerdulatinib is a dual inhibitor targeting both the JAK and spleen tyrosine kinase (Syk) pathways. Delgocitinib, a topical JAK inhibitor treatment for chronic hand eczema, is currently being assessed by NICE for use by the NHS and if approved could be available to patients in 2025.

Reducing itch

Some new topical treatments are aimed at reducing itch, which is one of the most challenging and distruptive symptoms for many people with eczema. For instance, tapinarof – which targets aryl hydrocarbon receptors (AHR) – has shown significant potential in alleviating itch in atopic eczema. Similarly, roflumilast, a phosphodiesterase type-4 inhibitor (PDE4), has been effective in clinical trials, particularly benefiting those with seborrheic eczema. Other similar drugs like lotamilast and difamilast may follow.

Tyrosine kinase inhibitors, working on similar pathways as JAK inhibitors, are also showing promise, with drugs like brepocitinib potentially leading the way. Additionally, vorapaxor, a blood-thinning drug, has been found to reduce itching, and a cream version is currently being tested.

Lastly, a new class of drugs that block the transient receptor vanilloid may also offer relief by reducing the secretion of neuropeptides in the skin, further helping to manage itch.

As these treatments continue to evolve and become more widely used, healthcare providers will gain more experience, making them a cornerstone of eczema management. With up to 70 new drugs in development for atopic eczema, the future holds immense potential. We’re witnessing a revolution in how this complex condition is treated, with more options than ever to tailor treatments to individual needs. Head-to-head trials like BEACON – which is supported by National Eczema Society – will be crucial in determining which treatments are the safest and most cost-effective for different patient groups.

Looking ahead, the use of biomarkers may help in selecting the most effective treatments for each patient, potentially combining therapies to target multiple inflammatory pathways. This could lead to lower dosages and reduced risk of long-term side effects. The BIOMAP study, another initiative supported by National Eczema Society, is making exciting progress in investigating biomarkers for atopic eczema and psoriasis.

The future for eczema sufferers is indeed bright and getting brighter every day!

*Professor Andrew Wright has a long association with National Eczema Society, as an expert advisor and member of the charity’s Medical Advisory Board. Appointed as a Consultant Dermatologist in Bradford in 1990, his research interests include eczema, psoriasis, and skin cancer. He is an associate clinical director of Bradford University’s Centre for Skin Science. In March 2020, Andrew retired from NHS clinical work but he remains active in clinical practice and research.