Oral medication for eczema: Types, benefits & side effects

Eczema is a type of dermatitis, a group of medical conditions that cause inflammation of the skin. People with eczema have dry, itchy skin. There are several types of eczema, the most common of which is atopic dermatitis. According to Cleveland Clinic, eczema is common and affects 31 million people in the United States. Anyone of any age can be affected, although symptoms generally start in childhood and persist through lifetime. People with skin conditions, allergies, or asthma (or a family history of one of these conditions) are at higher risk for eczema. 

There is no cure for eczema, according to the National Eczema Association. The good news, however, is there are many treatments available that can help keep symptoms under control. The best treatment for eczema depends on the type and severity of symptoms. More severe symptoms will require more intensive treatment. 

Lifestyle modifications like avoiding triggers, moisturizing regularly, and managing stress can help ease symptoms. Over-the-counter (OTC) or prescription oral antihistamines or topical corticosteroids can also help. A healthcare provider can also prescribe prescription topical medications, such as topical calcineurin inhibitors. 

Some people will require phototherapy (light therapy), injectable biologic medication, or stronger prescription oral medications in order to treat their eczema. There are various types of oral medications used for eczema, each with different benefits and side effects.  

Before taking oral medication for eczema

Because there are various oral medications for eczema—each with a different safety profile, possible side effects, and potential drug interactions—be sure to let your healthcare provider know the following information so they can determine which medication is appropriate for you:

• Your current and past medical conditions, including if you are pregnant, planning to become pregnant, or breastfeeding
• Your family history
• Allergies to medications
• Names of all the medications you take, including prescription medications, OTC drugs, vitamins, and supplements

Oral immunosuppressants for eczema

According to the National Eczema Association, the exact cause of eczema is unknown, but experts understand there is immune system involvement. When the immune system overreacts, it leads to inflammation and symptoms like itching and irritation of the skin. A healthcare provider may prescribe an immunosuppressant for moderate to severe cases of eczema. This can help calm down the immune system and control eczema symptoms. Generally, an immunosuppressant may be prescribed for a short time to control symptoms before a healthcare provider recommends switching to a topical medication. 

Immunosuppressants are not approved by the Food and Drug Administration (FDA) specifically to treat eczema, so their use in eczema is considered off-label. Because these medicines suppress the immune system, they can make you more susceptible to infections. They can also increase the risk for certain cancers and have other potentially serious side effects. Examples of oral immunosuppressants used for eczema include the following:

• Cellcept (mycophenolate) is FDA approved to prevent organ rejection in people who have had a liver, heart, or kidney transplant. Common side effects include vomiting, diarrhea, low white blood cell count, and infections.
• Cyclosporine is FDA approved to prevent organ rejection in people who have had a liver, heart, or kidney transplant. It can also be used to treat severe rheumatoid arthritis (RA) or severe psoriasis. Common side effects may include hypertension (high blood pressure), kidney problems, and excess hair growth on the body.
• Imuran (azathioprine) is FDA approved to prevent organ rejection after a kidney transplant. It can also be used to treat RA. Common side effects include nausea, vomiting, low white blood cells, and infections. 
• Methotrexate is FDA approved to treat certain types of cancers as well as RA and psoriasis. Common side effects include nausea, vomiting, mouth sores, low platelet levels, and increased liver function tests. People who take this medication must be closely monitored for problems with the bone marrow, stomach and intestines, liver, lungs, kidneys, and skin. 

Oral corticosteroids for eczema

According to the Allergy & Asthma Network, corticosteroids (steroids) such as prednisone, prednisolone, methylprednisolone, and dexamethasone can be used for severe eczema and help relieve symptoms of itching and swelling. These oral steroids can be given by mouth, and some can also be injected. Generally, steroids are prescribed for short-term use because of the possibility for serious side effects. Depending on the length of treatment, your healthcare provider may instruct you to taper off the medication gradually to avoid problems with the adrenal gland. 

According to Cleveland Clinic, steroid side effects may include:

• Increased appetite
• Weight gain
• Mood changes
• Weakness
• Body hair growth
• Easy bruising
• Increased risk of infection 
• Facial swelling
• Water retention 
• Acne
• Stomach irritation
• Difficulty falling or staying asleep
• Nervousness 

Long-term use may cause side effects like bone loss, diabetes, weight gain, and eye problems like cataracts and glaucoma. 

JAK inhibitors for eczema

Janus kinase (JAK) inhibitors are a newer class of drugs that work on a specific pathway in the immune system rather than suppressing the entire immune system. They block proteins called cytokines that can cause excess inflammation in the body. Two oral JAK inhibitors have been approved by the FDA for atopic dermatitis. Clinical trials have found that they work quickly, are very effective, and have resulted in significant improvements in patients who have not responded to other treatments. 

Cibinqo is a JAK inhibitor that contains the active ingredient abrocitinib and is made by the pharmaceutical manufacturer Pfizer. It is available in the form of a tablet that is taken by mouth once a day. Cibinqo is FDA approved to treat adults and adolescents ages 12 and older with moderate to severe atopic dermatitis when previous treatment (including biologics) has not been effective enough. Some common side effects of Cibinqo include:

• Common cold symptoms
• Stomach problems like nausea, vomiting, stomach flu, stomach pain 
• Headaches
• Herpes simplex infections
• Urinary tract infections 
• Acne 
• Fatigue 
• Hypertension 
• Dizziness 
• Low platelet levels, which can increase the risk of bruising and bleeding

Rinvoq is a JAK inhibitor that contains the active ingredient upadacitinib and is made by the pharmaceutical manufacturer AbbVie. It is available in the form of an extended-release tablet that is taken by mouth once a day. Rinvoq is FDA approved to treat adults and adolescents ages 12 and older with moderate to severe atopic dermatitis when other medications (including biologics) have not been effective enough. It can also be used to treat adults with other conditions, such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. Some common side effects of Rinvoq include:

• Upper respiratory infection 
• Nausea 
• Cough 
• Fever 

JAK inhibitors have a boxed warning, also called a “black box warning,” which is the most serious warning required by the FDA. This warning can be found in the prescribing information and on the package insert for each drug. The warning states that:

• There is an increased risk of infections that can lead to hospitalization or death, including tuberculosis (TB). Patients will be tested for TB before and during treatment with a JAK inhibitor. 
• Studies have shown a higher rate of death, heart attack, pulmonary embolism, clotting, and stroke with another JAK inhibitor drug in people with RA. (Cibinqo is not FDA approved for treating RA. 
• There may be an increased risk of cancer, specifically lymphomas and lung cancers. 

Oral antibiotics for eczema

According to NYU Langone Health, oral antibiotics are not routinely prescribed for eczema symptoms. Rather, they are only prescribed if an infection occurs. For example, if a rash or excess scratching causes skin breakage, then a doctor may prescribe an oral antibiotic for one to two weeks. This can help eliminate bacteria and prevent the infection from spreading. Common side effects of antibiotics include nausea, vomiting, and diarrhea—although specific side effects vary based on the medication, as there are various types of antibiotics. 

Oral antihistamines for eczema

Antihistamines work by blocking histamines, substances that cause symptoms like itching and inflammation. Histamines also cause allergy symptoms like sneezing, runny nose, and watery, itchy eyes—which is why antihistamines are often used to treat allergy symptoms. If you have eczema and allergies, your healthcare provider may suggest you try an oral antihistamine. 

First-generation antihistamines, such as Benadryl (diphenhydramine), were the first antihistamines developed, according to the American Academy of Family Physicians. They are known for causing sedation and drowsiness, which may make them an undesirable choice of medication in older adults who are more sensitive to the side effects. On the other hand, this side effect of drowsiness may sometimes be used as an advantage for people who cannot sleep due to eczema symptoms.

Second-generation antihistamines are often referred to as nonsedating antihistamines. They may still cause some drowsiness but to a lesser extent than first-generation antihistamines. Examples of second-generation antihistamines include:

• Claritin (loratadine)
• Allegra (fexofenadine)
• Zyrtec (cetirizine)
• Xyzal (levocetirizine) 

Bottom line

Eczema can cause uncomfortable symptoms and interfere with your quality of life. Although there is no cure, there are many treatments available to help prevent and control symptoms like itching and inflammation. In moderate-to-severe eczema cases, an oral medication may be required. Consult your healthcare professional for more information and medical advice about the benefits and risks of oral eczema medication.