More than 31 million Americans have eczema (also called atopic dermatitis). Half of them say they're frustrated by this itchy skin condition. Creams can help relieve the itch, and steroids bring down the inflammation. But experts still don’t know how to get rid of eczema for good.
In recent years, researchers have learned more about the causes of eczema and the triggers that set off flares of redness and itching. Their discoveries are paving the way for new methods to prevent and treat eczema.
Searching for the Cause
One contributor to eczema is too few of the fats and other elements in the layers of the skin that protect the skin's outer barrier. When these elements are in short supply, bacteria can slip inside cracks in the skin.
Recently, researchers discovered that bacteria in the skin isn't just a result of eczema, but also a possible cause. Once inside, bacteria may irritate and inflame the skin.
Some research efforts to prevent eczema focus on family history and genes. Researchers believe that certain genes you get from your parents raise the risk for eczema. Then environmental factors trigger the disease.
One important gene is FLG, which helps keep the skin moist and prevents allergens, bacteria, and other harmful substances from getting in. A change or mutation in this gene can increase the risk for eczema.
Scientists recently found 118 other genes linked to both eczema and psoriasis -- another skin condition that runs in families. They also discovered variants in the gene KIF3A that weaken the skin's natural barrier. This causes skin to lose water and dry out.
Researchers continue to find new genes linked to eczema. These genes could help experts learn more about the causes of eczema and find new ways to treat it. One day scientists might develop a genetic test that can predict which children will develop eczema. Or they could develop a drug that could switch off genes that help cause the skin condition.
A few new medications are changing the way doctors treat eczema.
Until 2017, medication options for eczema were pretty much just steroids and anti-itch creams. Then, the FDA approved dupilumab (Dupixent), a type of drug called a monoclonal antibody. You inject it just under your skin. It blocks two chemicals in your immune system that cause inflammation in people with eczema.
Two other drugs that would work in the same way -- lebrikizumab and tralokinumab -- are in development. Another drug, nemolizumab, which is still in the experimental phase, blocks a protein that causes the itch in eczema.
The next big thing in eczema treatment is a group of drugs called Janus kinase (JAK) inhibitors. They can block JAK proteins. These substances trigger the release of chemicals that inflame the skin in eczema.
A few JAK inhibitors are in late-stage clinical trials for eczema. Research so far shows they clear up the skin and reduce itch. One experimental drug, abrocitinib, relieved itch better than Dupixent in one study. JAK inhibitors come in a pill and a cream, instead of an injection like Dupixent.
JAK inhibitors are already a treatment for rheumatoid arthritis and psoriatic arthritis.
Researchers have known for a while that people with atopic dermatitis have large numbers of staph bacteria living on their skin. These bacteria not only cause infection, but they also trigger the immune responses that increase swelling and redness.
Now scientists are looking at whether helpful bacteria, called probiotics, might kill harmful ones in the skin and help treat this condition. Studies done in mice and human cells showed that a type of bacteria called Roseomonas mucosa improved eczema symptoms and reduced the need for steroid medicines in children. Future studies should shed more light on whether bacteria are a safe and effective eczema treatment.
The search is also on for nondrug remedies that relieve eczema redness and itch. A few alternative therapies have shown positive effects in studies, including:
- East Indian sandalwood
- Evening primrose oil
- Manuka honey
- Vitamins B12, D, and E
Although these treatments look promising, there isn't enough evidence yet to recommend using any of them for eczema.