Thanks for the question.
Eczema is a common skin condition and most cases of eczema can be treated effectively with topical medications such as topical steroids and moisturizers.
In cases where the eczema is moderated to severe and when topical medications are not controlling the eczema well, we can consider starting on oral immunosuppressive medications.
Oral immunosuppresive medications have their own set of side effects. The commonly used medications include oral cyclosporine, methotrexate and azathioprine. These medications do suppress the immune system and can lead to an increased susceptibility to infection. Depending on the medications taken, they can also affect the kidney, liver, blood counts and blood pressure, and there may be a slight increase risk of malignancy. There will be strict monitoring with regular blood tests while on the treatment to ensure the safe and effective use of these medications. While the side effects may sound daunting, we have used these treatments safely in many patients with moderate to severe eczema with good results.
There is now a new treatment for atopic eczema called dupilumab which has recently been approved in Singapore. This is a new class of medication known as biologics and is the first to be approved for the treatment of eczema. This is given as a subcutaneous injection. The advantage over the traditional oral medications is its safety profile as it is not immunosuppressive and does not harm the liver, kidneys and affect the blood counts. It has been proven to be effective in the treatment of atopic eczema and would be a good option for individuals with moderate to severe eczema who are unable to tolerate the side effects of the oral medications. I have used it in my patients and have found it to be effective and well tolerated.
