Balancing hype against risk

to overcome eczema

If you have been watching television recently, you have no doubt seen advertisements for drugs to treat eczema. People who don’t suffer from eczema (a condition doctors call “atopic dermatitis”) may have a hard time understanding the fuss. The commercials mention itch and imply that the associated redness and scaling is embarrassing.

A study in Austria and Switzerland found that patients often don’t get a prompt diagnosis (Journal of Dermatological Treatment, Oct. 17, 2024). In the meantime, they suffer moderate to severe itching and reduced quality of life. Despite treatment, they were still having trouble with their sleep, mental health, social life and work productivity.

Scientists are still working to understand exactly why some people have such difficulty with eczema. It seems to be an autoimmune condition in which the body’s immune system begins to attack some cells in the skin. The balance of microbes on the skin, in the digestive tract and in the lungs may all contribute to make certain individuals susceptible (Scandinavian Journal of Immunology, Oct. 21, 2024).

Deficiencies in the skin’s barrier function may make eczema worse. In addition, people who have other conditions such as seasonal allergies, chronic sinus inflammation, asthma or food allergies seem to be more likely to experience the irritation, rash and itch that signals eczema (International Journal of Molecular Sciences, Sept. 25, 2024).

Fortunately, there are other steps to try before jumping straight to the pricey medications advertised on TV. First of all, patients should try to avoid soaking the affected parts (such as hands) in hot water or using harsh detergents. These can dry the skin and disrupt its barrier, making eczema worse, while a gentle nonsoap cleanser like CeraVe or Cetaphil should be fine. The National Eczema Association suggests a quick lukewarm bath rather than a long, hot bath or shower.

Some research suggests that probiotic supplements, particularly those containing a Lactobacillus species as an ingredient, may help alleviate symptoms without triggering serious side effects (Cureus, July 18, 2024). Dermatologists have debated whether omega-3 fats of the sort found in fish oil might be helpful. One recent randomized trial suggests that it can ease eczema in children (Nutrients, Aug. 24, 2024). The benefits for adults are not as clear.

By now, you may have gotten the picture of why the powerful prescription drugs in TV commercials might be so appealing. People in these spots are having fun snorkeling, riding horses, roller skating and surfing. Their eczema does not seem to be slowing them down at all. Who wouldn’t want a life like that?

Rinvoq (upadacitinib) is probably appropriate in some situations. The prescribing information for dermatologists specifies that it should be reserved for people who have not responded to other treatments, including biologics. Presumably, that is because Rinvoq has the potential to cause some very serious side effects. These are mentioned in the ad, but rather quickly, so if you missed them, here they are:

“Rinvoq can lower your ability to fight infections including TB. Serious infections and blood clots, some fatal, cancers including lymphoma and skin, heart attack, stroke and GI tears occur. People 50 and older with a heart disease risk factor have an increased risk of death. Serious allergic reactions can occur. Tell your doctor if you are or may become pregnant.”

Eczema can be extremely uncomfortable. It is, however, not lethal. We think people should exhaust all other options before considering a medication that could cause cancer, heart attacks or strokes.

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In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”

(c) 2024 King Features Syndicate, Inc.