Conventionally eczema patients will be given corticosteroids to shut down the inflammation, then use aggressive moisturiser to heal the skin barrier, then neuromodulatory drugs and sometimes together with antidepressants like mirtazapine. The eczema start to get progressively worse despite having increased the potency of steroid cream applied.
Following, they will be administered with phototherapy, eg. UVA, UVB, then escalated up to systemic immunosuppressants, eg. steroids prednisolone, cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, then, more recently, biologic immunosuppressants, eg. nemolizumab, tralokinumab, labrikizumab, upadacitinib, rituximab, mapolizumab, omalizumab, ustekinumab. Then they are waiting for next upcoming immunosuppressants…
Scientists studies report that eczema seems to be associated with certain genes, which however do not necessarily cause eczema. Eczema is not simply immunologic, it is not simply neuropathic, and it is not simply in the epithelial barrier, but probably a combination of all these, may even more.