This Once-daily Pill Relieves Moderate to Severe Eczema – Here’s What Dermatologists Say

Looking for a new way to manage your eczema? A once-daily pill called abrocitinib could be a game-changer, especially for those with moderate-to-severe cases.

Plus, this medication offers relief beyond topical solutions and is even subsidised by the government!

To learn more about the science behind abrocitinib, its effectiveness, and how safe it is as a treatment option for eczema, we spoke with consultant dermatologists Dr Roland Chu from Loke Skin Clinic and Dr Mark Tang from The Skin Specialists and Laser Clinic.

So, is abrocitinib right for you? How does it work? And will you still need topical treatments? Read on to get all your queries answered, plus how you should be managing eczema.

Eczema Conditions in Singapore

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The occurrence of eczema in Singapore is one of the highest in the world – with one out of five children and one in 10 adults suffering from this condition. While there is no single medication which will cure eczema, it is possible to control eczema effectively through different treatment plans. Today, we join Dr Lucinda Tan, Head of the Paediatric Dermatology Clinic at the National Skin Centre, and two siblings – Dorothy and Dylan – in their journey as they learn how to care for their skin, as part of managing this condition.  #nhgcares

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According to CNA Lifestyle, eczema (particularly atopic dermatitis) is a chronic inflammatory skin condition that affects 11% of adults and a staggering 20% of children in Singapore. While adult-onset eczema is less common, many develop it after age 21.

The symptoms can be disruptive and uncomfortable; itchy patches of skin with flaking, cracking, swelling, oozing, crusting, dryness, pain, and sensitivity are all hallmarks of eczema.

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These symptoms can vary in intensity and come and go. While mild cases may be managed with a good moisturiser, more severe eczema requires a more targeted approach.

Here’s where science, innovation, and abrocitinib come in.

How Does Abrocitinib Work?

Abrocitinib works differently from traditional eczema medications. It’s a JAK inhibitor, which stands for Janus kinase inhibitor.

“JAK inhibitors are small molecules that block the chemical signals in the body that drive many inflammatory diseases such as atopic eczema. There are four members in the JAK family (JAK1, JAK2, JAK3, TYK2), and abrocitinib can block JAK1 selectively.

We know that JAK1 plays an important role in driving eczema. As such, by blocking JAK1, abrocitinib can very effectively reduce inflammation, with consequent improvement in the itch and rash that eczema patients experience,” Dr Chu explained.

In other words, JAKs are like messengers inside your immune cells, and they can sometimes go into overdrive in eczema, leading to inflammation.

Abrocitinib steps in and quiets these messengers down (specifically JAK1), reducing the production of inflammatory molecules called cytokines. These cytokines are the culprits behind many eczema symptoms like itching and redness.

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There is a newer type of eczema treatment called JAK inhibitors. What are JAK inhibitors? This may be an option for you if you’re struggling with your eczema #eczema #eczemaawareness #skincare #medication #tiktokdoc #learnontiktok

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Think of it like this: JAKs are like a fire alarm system in your body, and cytokines are the firefighters. In eczema, the alarm is constantly going off, even when there’s no fire. Abrocitinib acts like a dimmer switch, calming the alarm and preventing the firefighters from being called out unnecessarily.

Abrocitinib also works systemically, meaning it reaches and affects cells throughout your body — similar to how paracetamol fights headaches throughout, not just at the source of pain.

This targeted approach is what makes abrocitinib so promising for moderate-to-severe eczema, providing hope for those whose eczema isn’t adequately controlled by creams or ointments since the inflammation is addressed at its source.

How Promising is Abrocitinib for Eczema?

Clinical trials conducted by the National Eczema Society in the UK painted a promising picture for abrocitinib. Over 3,800 adults and adolescents with moderate-to-severe eczema participated.

They were divided into three groups: one receiving a daily 100mg dose, another receiving a daily 200mg dose, and a third receiving a placebo for twelve weeks.

The results were encouraging. Compared to the placebo group, abrocitinib significantly reduced eczema severity, inflammation, and itch throughout the entire study period.

Notably, participants experienced relief from itching as early as 24 hours after starting abrocitinib, highlighting its potential for rapid improvement.

On that note, Dr Chu shared that abrocitinib is undoubtedly a very effective treatment for atopic eczema.

“In fact, many of my patients often notice a dramatic reduction in itch within hours of starting the medication, although the eczema rash itself may take around two weeks to improve noticeably.

Sleep quality is often poor in patients with moderate to severe eczema. With this reduction in itch after starting abrocitinib, it is not surprising that eczema sufferers are then able to sleep better, which translates to better work and study performance,” Dr Chu added.

Are There Any Risks or Side Effects to Taking Abrocitinib Pills?

Is abrocitinib simply too good to be true? Well, like all JAK inhibitors, abrocitinib is a powerful suppressor of the immune system. As such, Dr Chu noted that patients on abrocitinib are at an increased risk of infection.

“Thankfully, most of these infections are mild (the common cold). However, patients taking abrocitinib are more likely to develop shingles so eczema sufferers considering abrocitinib should consider getting vaccinated for shingles prior to starting treatment,” Dr Chu stated.

What may alarm patients, however, is the FDA black box warning carried by all JAK inhibitors, which warns of the risk of cancer, blood clots, serious heart-related events, and even death.

With regards to that, Dr Chu pointed out that “it’s important to know that the warning came from a study related to an older JAK inhibitor not used for eczema”.

“To date, there has been no evidence of an increased risk of these serious side effects in any of the JAK inhibitors (including abrocitinib) that are approved for use in atopic eczema.

In general, most patients who take abrocitinib do not develop any side effects, with the most common side effects being nausea and headache that are usually mild and improve over time,” assured Dr Chu.

Additionally, Dr Tang shared, “So far, the safety data in dermatology has been encouraging, but long-term data is still needed. There is also a need for baseline and regular blood tests to monitor for any adverse effects.

It is important to discuss and weigh the benefits, risks and costs before starting any long-term systemic medications.”

Could Eczema Pills Work Better Than Topical Products?

Topical therapy is typically safer and serves as the first-line treatment for atopic eczema.

In the case of patients with mild eczema, regularly applying moisturisers along with the occasional use of topical steroids or immunomodulators is often sufficient to manage the condition.

“JAK blockers are approved to treat only severe or recalcitrant cases of atopic dermatitis. The majority of patients can still be well managed with topical medications and moisturizers, without the need for oral or systemic options.

For severe cases, both oral and topical medications are necessary and should be used concurrently,” said Dr Tang.

Dr Chu also confirmed that systemic treatments (oral or injection) are generally only considered when the eczema is inadequately controlled by topical treatments.

“All eczema patients are advised to continue long-term use of moisturisers, whether they are on JAK inhibitors or not. Some patients may still need the occasional use of topical steroids/immunomodulators despite being on JAK inhibitors,” he said.

Is Anyone With Eczema Suitable for This Tablet?

“JAK blockers cannot be used in very young children, pregnant or breastfeeding women, those with certain medical conditions and the elderly.

It’s important to consult a skin specialist to assess and discuss the most appropriate option that is personalised to the patient’s severity, medical condition and expectations,” asserted Dr Tang.

He also shared that other options used to treat severe atopic dermatitis include phototherapy, biologic injections such as Dupilumab, oral immunosuppressive agents such as methotrexate or ciclosporine, and other oral JAK blockers like baricitinib and upadacitinib.

“Abrocitinib is approved for use in patients with moderate to severe eczema who are 12 years and older. I would consider starting eczema patients on systemic treatments like abrocitinib if their eczema is not adequately controlled by topical treatment alone.

Ultimately, the choice to use any systemic treatment should be a shared decision between patients, caregivers and their dermatologists,” Dr Chu noted.

How Do I Get a Subsidised Prescription for Abrocitinib?

Those grappling with moderate to severe eczema conditions, visit your doctor, dermatologist, or the nearest healthcare provider for an in-depth consultation.

For the uninitiated, on 1 March 2024, abrocitinib was added to the Ministry of Health’s Medication Assistance Fund (MAF) list. That means you may be eligible for up to 75% off the medication’s cost, depending on your monthly per capita household income (PCHI).

Patients with a monthly PCHI of between S$2,800 and S$6,500 are eligible for a subsidy of up to 50%.

Before starting abrocitinib, remember to inform your doctor if you’re already taking other medications like antacids, fluvoxamine, or more, as there may be contradictions with the eczema pill.

So, what are your thoughts? Will this once-daily eczema pill really offer hope and relief for those suffering from eczema?

About Dr Roland Chu and Dr Mark Tang

Dr Roland Chu

Dr Roland Chu is a highly qualified Consultant Dermatologist renowned for his expertise in treating a wide range of medical and aesthetic skin, hair, and nail conditions in both adults and children.

With a PhD in dermatology and a strong focus on eczema research, he obtained his medical degree from the University of Edinburgh after completing an honours degree in Biochemistry from the University of Wisconsin-Madison.

He holds dual registration with the General Medical Council (UK) and the Singapore Medical Council and is a member of prestigious dermatological associations. Dr Chu’s extensive training and experience in the UK and Singapore have equipped him with a deep understanding of diverse skin types.

Prior to joining Skin Physicians, he served as a Consultant Dermatologist at prominent institutions such as the Edinburgh Royal Infirmary (UK) and the National Skin Centre (Singapore).

Recognised for his patient-centred approach, Dr Chu has received accolades for his contributions to dermatological care and continues to serve as a Visiting Consultant at renowned medical centres.

Additionally, he actively contributes to international dermatological research, focusing particularly on eczema causes and treatments.

Dr Mark Tang

Dr Mark Tang, a highly respected Consultant Dermatologist, boasts over two decades of exceptional clinical practice.

Renowned as a key opinion leader in eczema, immune-mediated skin diseases, wound healing, and skin cancers, he is sought-after globally for his expertise, serving as a speaker and faculty member in various conferences and advisory boards.

Before establishing The Skin Specialists and Laser Clinic, he held prestigious roles at the National Skin Center, where he garnered numerous accolades for his patient-centred approach and dedication to teaching.

With a stellar academic background and extensive training both locally and abroad, Dr. Tang has made significant contributions to dermatological research, particularly in acne and eczema.

He continues to play a pivotal role in dermatology education and accreditation, reflecting his commitment to patient care and excellence in dermatology.

Dr Tang’s unwavering dedication to his patients underscores his philosophy of treating each individual with the utmost respect and care.

Featured image credits: @nhgcares/TikTok, Depositphotos, @rubin_allergy