Editing Dermatitis (section)

====Immunosuppressants====
[[File:Protopic.JPG|thumb|Tacrolimus 0.1%]]
Topical [[immunosuppressant]]s like [[pimecrolimus]] and [[tacrolimus]] may be better in the short term and appear equal to steroids after a year of use.<ref>{{cite journal | vauthors = Shams K, Grindlay DJ, Williams HC | title = What's new in atopic eczema? An analysis of systematic reviews published in 2009-2010 | journal = Clinical and Experimental Dermatology | volume = 36 | issue = 6 | pages = 573–577; quiz 577–578 | date = August 2011 | pmid = 21718344 | doi = 10.1111/j.1365-2230.2011.04078.x | s2cid = 42321918 | doi-access = free }}</ref> Their use is reasonable in those who do not respond to or are not tolerant of steroids.<ref name="Carr2013">{{cite journal | vauthors = Carr WW | title = Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations | journal = Paediatric Drugs | volume = 15 | issue = 4 | pages = 303–310 | date = August 2013 | pmid = 23549982 | pmc = 3715696 | doi = 10.1007/s40272-013-0013-9 }}</ref><ref>{{cite web|url=http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Treatment.aspx|title=Atopic eczema - Treatment|publisher=NHS Choices, London, UK|date=12 February 2016|access-date=27 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170116200857/http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/treatment.aspx|archive-date=16 January 2017}}</ref> Treatments are typically recommended for short or fixed periods of time rather than indefinitely.<ref name=Mc2012/><ref name="fda14">{{cite web|url=https://www.fda.gov/downloads/drugs/drugsafety/ucm088587.pdf|title=Medication Guide. Elidel® (pimecrolimus) Cream, 1%|publisher=US Food and Drug Administration|date=March 2014|access-date=27 January 2017|url-status=dead|archive-url=https://web.archive.org/web/20170211080101/https://www.fda.gov/downloads/Drugs/DrugSafety/UCM088587.pdf|archive-date=11 February 2017}}</ref> Tacrolimus 0.1% has generally proved more effective than pimecrolimus, and equal in effect to mid-potency topical steroids.<ref name=Tor2013>{{cite journal | vauthors = Torley D, Futamura M, Williams HC, Thomas KS | title = What's new in atopic eczema? An analysis of systematic reviews published in 2010–11 | journal = Clinical and Experimental Dermatology | volume = 38 | issue = 5 | pages = 449–456 | date = July 2013 | pmid = 23750610 | doi = 10.1111/ced.12143 | s2cid = 24638685 }}</ref> There is no association to increased risk of cancer from topical use of pimecrolimus nor tacrolimus.<ref name=fda14/><ref>{{Cite journal |last1=Devasenapathy |first1=Niveditha |last2=Chu |first2=Alexandro |last3=Wong |first3=Melanie |last4=Srivastava |first4=Archita |last5=Ceccacci |first5=Renata |last6=Lin |first6=Clement |last7=MacDonald |first7=Margaret |last8=Wen |first8=Aaron |last9=Steen |first9=Jeremy |last10=Levine |first10=Mitchell |last11=Pyne |first11=Lonnie |last12=Schneider |first12=Lynda |last13=Chu |first13=Derek K. |last14=Asiniwasis |first14=Rachel Netahe |last15=Boguniewicz |first15=Mark|date=1 January 2023 |title=Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis |url=https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00283-8/abstract |journal=The Lancet Child & Adolescent Health |language=English |volume=7 |issue=1 |pages=13–25 |doi=10.1016/S2352-4642(22)00283-8 |issn=2352-4642 |pmid=36370744|s2cid=253470127 |url-access=subscription }}</ref>

When eczema is severe and does not respond to other forms of treatment, systemic [[immunosuppressant]]s are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are [[cyclosporin]], [[azathioprine]], and [[methotrexate]].

[[Dupilumab]] is a new{{notetag|[[Dupilumab]] received approval from the US [[Food and Drug Administration]] for moderate-to-severe atopic dermatitis in 2017<ref>{{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |title=FDA approves new eczema drug Dupixent |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=10 September 2019 |access-date=29 March 2017 |archive-date=28 March 2017 |archive-url=https://web.archive.org/web/20170328204026/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |url-status=dead }}</ref> and for asthma in 2018.<ref>{{cite web | title=Dupixent- dupilumab injection, solution | publisher=[[DailyMed]] | date=25 June 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | access-date=17 September 2020 | archive-date=24 March 2021 | archive-url=https://web.archive.org/web/20210324191531/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780 | url-status=live }}</ref>}} medication that improves eczema lesions, especially moderate to severe eczema.<ref>{{cite journal | vauthors = Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N | title = Systemic treatments for eczema: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013206 | date = September 2020 | issue = 9 | pmid = 32927498 | pmc = 8128359 | doi = 10.1002/14651858.cd013206.pub2 }}</ref> Dupilumab, a monoclonal antibody, suppresses inflammation by targeting the [[interleukin-4 receptor]].