Persistent eczema can be frustrating — flare-ups, itching, and sleepless nights often interfere with daily life. Fortunately, dermatology has advanced significantly, introducing therapies that address the root causes of inflammation rather than just managing symptoms. From biologics to microbiome-based solutions, patients now have more personalized options for long-term relief. Whether you’re exploring medical or holistic solutions, consulting the best dermatologist in Singapore can help determine which innovative treatment aligns best with your specific condition and lifestyle.
Did you know that JAK inhibitors can reduce eczema itching within 24-48 hours of starting treatment? Eczema treatment has evolved with the introduction of targeted therapies that address specific inflammatory pathways. JAK inhibitors like upadacitinib and abrocitinib provide oral alternatives to traditional immunosuppressants, with improvement typically observed within 2-4 weeks for moderate to severe cases. Biologics such as dupilumab and tralokinumab target interleukin pathways directly, reducing inflammation without broadly suppressing the immune system. These medications represent a shift from managing symptoms to interrupting the disease process itself, providing relief for patients who haven’t responded to conventional treatments.
The development of microbiome-based therapies and refined phototherapy protocols has expanded treatment options beyond pharmaceutical interventions.
JAK Inhibitors
Janus kinase (JAK) inhibitors block specific enzymes involved in the inflammatory cascade that drives eczema. Upadacitinib targets JAK1 selectively, while abrocitinib inhibits both JAK1 and JAK2, with different efficacy and side effect profiles. These oral medications work within cells to prevent the production of inflammatory cytokines, rather than neutralizing them after release.
JAK inhibitors can achieve improvement in eczema symptoms within 12-16 weeks. The onset of action addresses both skin inflammation and itch, with some patients reporting reduced itching within 24-48 hours of starting treatment. This differs from traditional systemic medications like methotrexate or azathioprine, which may require 8-12 weeks for noticeable improvement.
Regular monitoring includes complete blood counts every 3 months initially, lipid panels at baseline and 4 weeks, and liver function tests. JAK inhibitors may increase susceptibility to certain infections, particularly herpes zoster, making vaccination considerations important before starting therapy. The medications offer flexibility in dosing, with options to adjust based on response and tolerability.
Biologic Therapies
Dupilumab, an FDA-approved biologic for eczema, blocks interleukin-4 and interleukin-13 signaling through receptor antagonism. Administered as subcutaneous injections, it reduces inflammation while maintaining normal immune function against infections. Tralokinumab, targeting only IL-13, provides an alternative for patients who develop conjunctivitis on dupilumab or prefer different dosing schedules.
These biologics demonstrate sustained efficacy over multiple years of treatment without the organ toxicity associated with traditional immunosuppressants. Injection site reactions occur in some patients and typically resolve without intervention. The medications don’t require routine laboratory monitoring beyond initial screening, reducing the burden of frequent medical visits.
Lebrikizumab and nemolizumab represent emerging biologic options currently in late-stage trials. Lebrikizumab targets IL-13 with high affinity, while nemolizumab blocks IL-31, a mediator of itch in eczema. These additions to the biologic options may allow more personalized treatment selection based on predominant symptoms and previous treatment responses.
Microbiome Therapy
The skin microbiome in eczema patients shows reduced diversity and Staphylococcus aureus overgrowth. Treatments aim to restore microbial balance through targeted approaches. Topical application of commensal bacteria like Roseomonas mucosa has been studied in early trials, with results showing reduction in disease severity and S. aureus colonization without antibiotics.
FB-401, a topical live biotherapeutic containing three commensal strains, completed Phase 1 trials demonstrating safety and preliminary efficacy. The treatment applies beneficial bacteria directly to affected skin, where they compete with pathogenic organisms and produce antimicrobial peptides. This approach may help address antibiotic resistance concerns while targeting the underlying dysbiosis.
Endolysin-based therapies represent another microbiome-targeted strategy. These enzymes specifically target S. aureus cell walls without affecting beneficial bacteria. Products containing the endolysin Staphefekt SA.100 are available in some markets as a medical device for eczema-prone skin. Clinical studies show reduction in S. aureus load correlates with improved barrier function and reduced inflammation.
Targeted Phototherapy
Excimer laser therapy delivers focused 308-nm ultraviolet B light to affected areas while sparing healthy skin. This approach allows higher therapeutic doses than traditional phototherapy, potentially achieving clearance with fewer sessions. Treatment typically requires 10-20 sessions over 5-10 weeks, with patients often maintaining improvement for several months.
Home phototherapy devices with built-in dosimetry and safety features now enable consistent treatment without frequent clinic visits. These units connect to smartphone apps that track cumulative doses, remind patients of treatment schedules, and alert dermatologists to adherence patterns. The combination of professional oversight and home convenience may improve treatment completion rates.
Combination protocols using phototherapy with topical calcineurin inhibitors or vitamin D analogs may enhance efficacy while potentially reducing total UV exposure. The synergistic effects allow lower doses of each modality, potentially minimizing side effects while maintaining therapeutic benefit. Sequential therapy, alternating between phototherapy and topical treatments, provides another strategy for long-term management.
Topical Innovations
Ruxolitinib cream, a topical JAK inhibitor, provides targeted therapy without systemic exposure. Applied twice daily to affected areas, it reduces inflammation and itch within days. The medication maintains efficacy with continuous use and demonstrates a favorable safety profile in clinical trials extending beyond 52 weeks.
Tapinarof, a therapeutic aryl hydrocarbon receptor agonist, represents a mechanism in topical therapy. This non-steroidal medication reduces inflammation while promoting barrier repair and antimicrobial peptide production. Once-daily application can achieve clear or almost clear skin within 12 weeks.
PDE4 inhibitors like crisaborole and other agents under development target phosphodiesterase-4, an enzyme that promotes inflammation. These non-steroidal options work well for mild to moderate eczema, particularly in sensitive areas where topical steroids may cause adverse effects. The absence of skin atrophy or telangiectasia risk makes them suitable for long-term maintenance therapy.
💡 Did You Know?
The skin barrier in eczema patients shows reduced filaggrin production, leading to increased water loss and allergen penetration. Ceramide-based formulations mimic the lipid ratios found in healthy skin, improving barrier repair beyond traditional moisturizers.
What Our Dermatologist Says
The availability of multiple targeted therapies has shifted our approach from sequential trial-and-error to precision medicine. We now consider specific inflammatory pathways, patient preferences for administration routes, and lifestyle factors when selecting treatments.
Combination therapy often provides beneficial results – using biologics or JAK inhibitors for systemic control while maintaining topical treatments for breakthrough symptoms. The goal extends beyond skin clearance to addressing quality of life impacts like sleep disruption and psychological burden.
Patient education about realistic timelines and potential side effects improves treatment adherence and outcomes. Current therapies typically require several months for full effect, though symptomatic improvement often occurs sooner.
Putting This Into Practice
- Document your eczema triggers, flare patterns, and response to current treatments in a symptom diary to guide treatment selection
- Discuss vaccination status with your physician before starting JAK inhibitors or biologics, as live vaccines are contraindicated during treatment
- Establish a consistent skincare routine using ceramide-containing moisturizers twice daily, even when using systemic medications
- Consider patch testing if contact dermatitis complicates your eczema, as identifying and avoiding allergens improves treatment response
- Explore patient assistance programs from pharmaceutical companies if cost barriers limit access to therapies
When to Seek Professional Help
- Eczema covers more than 10% of body surface area despite consistent topical therapy
- Sleep disruption from itching occurs more than twice weekly
- Skin infections develop repeatedly, indicated by honey-colored crusting or spreading redness
- Current treatments cause intolerable side effects or lose effectiveness
- Quality of life impacts interfere with work, school, or relationships
- Facial or genital involvement may require specialized treatment approaches
Commonly Asked Questions
How do I know if I’m a candidate for biologic therapy?
Biologics are typically considered when moderate to severe eczema persists despite appropriate topical therapy and phototherapy trials. Your dermatologist will assess disease severity using validated scoring systems, evaluate previous treatment responses, and screen for contraindications like active tuberculosis or hepatitis.
Can I use JAK inhibitors if I’ve had previous infections?
Previous common infections don’t preclude JAK inhibitor use, but recurrent or severe infections require careful evaluation. Your physician will review your infection history, check immunity markers, and may recommend preventive measures like zoster vaccination before starting treatment.
How long do I need to continue these treatments?
Patients often require ongoing therapy to maintain improvement, though some achieve prolonged remission allowing dose reduction or treatment holidays. Regular follow-ups help determine the minimum effective maintenance regimen for your specific case.
Are these treatments safe during pregnancy?
Current guidelines recommend avoiding JAK inhibitors and most biologics during pregnancy due to limited safety data. Some topical treatments like crisaborole have favorable pregnancy categories. Preconception counseling helps plan safe treatment transitions.
What happens if the first biologic doesn’t work?
Non-response to one biologic doesn’t predict failure with others, as they target different inflammatory pathways. Switching between biologics or combining with other modalities often achieves control when monotherapy fails.
Next Steps
Consider JAK inhibitors for rapid itch relief, biologics for long-term inflammation control, or microbiome therapies if recurrent infections complicate your eczema. Document your triggers and current treatment response to guide selection between these targeted options.
If you’re experiencing persistent eczema symptoms, sleep disruption from itching, or recurrent skin infections, consult a dermatologist to evaluate these advanced treatment options.
