Living with moderate-to-severe eczema can be frustrating, especially because it may be hard to find a treatment that works for you. You may try different medications without getting any relief, or your symptoms may improve and then get worse again.
For decades, doctors didn’t have any options to treat moderate-to-severe eczema except for topical steroids. But in 2017, the first game-changing medication — the biologic dupilumab — became available. It’s a type of drug that blocks interleukins, which are proteins that make your immune system overactive, triggering eczema symptoms like redness and itching.
Since then, the FDA has approved three new biologics, as well as another class of medicines called JAK inhibitors. These block enzymes inside your cells to stop your immune system from becoming overactive and causing inflammation.
These drugs have made a big difference in treatment for people with moderate-to-severe eczema. But “we don’t have a drug that’s a consistent home run in just about everybody,” says Matthew Zirwas, MD, a dermatologist at Bexley Dermatology in Columbus, Ohio. Research shows that about half of people with moderate-to-severe eczema don’t have good control of their condition. “Some of that’s due to patients not being on these new medicines, like biologics and JAK inhibitors, but anecdotally 15%-20% of patients on them still don’t get good relief of symptoms,” Zirwas adds.
The good news is new therapies are constantly being developed. In the last couple of years, the FDA has approved several new treatments:
- Delgocitinib (Anzupgo) — a cream for hand eczema
- Difamilast (Adquey) — an ointment
- Nemolizumab-ilto (Nemluvio) — an injectable biologic
- Tapinarof (Vtama) — a topical cream
Longer Dosing Schedules
Most biologics need to be given every two to four weeks. But in June 2026, the FDA approved a new dosing schedule for the biologic lebrikizumab-lbkz (Ebglyss), which treats moderate-to-severe eczema in adults and kids who are at least 12. This means you only need to give yourself or your child a maintenance injection once every eight weeks, instead of once every four weeks. Research shows this dosing works just as well to control your eczema, even though you take it less frequently.
Now, a new experimental biologic, zumilokibart, is being studied to treat eczema that may allow you to go anywhere from three to six months between maintenance doses. It targets interleukin-13 (IL-13), an inflammatory chemical in your body that causes eczema. The drug significantly improves symptoms in about two-thirds of people with moderate-to-severe eczema. “It seems to be about as effective as other biologics available for eczema, but the difference is you’ll have to take it less often,” explains JiaDe Yu, MD, Chair of the Department of Dermatology for the VCU School of Medicine in Richmond, Virginia. “This can help to relieve some of the burdens involved with biologics, like frequent self-injections and high copay costs.”
New Treatment Approaches
Most eczema drugs block receptors that cause inflammation. But a new investigational drug called KT-621, which is taken daily as a pill, works differently. It selectively breaks down a protein called STAT6, which then shuts down inflammatory pathways driven by two chemicals in the body, IL-4 and IL-13. Initial, small studies show that over three-quarters of patients see their eczema symptoms improve by at least 50%. Almost 20% found that their eczema went away almost entirely. “We’re excited about it because we think it will be as much of a game changer as when Dupixent was approved back in 2017, but since it’s a once-daily pill, it will be much easier for patients to access,” Yu explains.
KT-621 is being compared to JAK inhibitors, which are also pills that are very effective for moderate-to-severe eczema. But FDA requires them to carry a black box warning, as they carry a very small risk for heart attacks, stroke, and blood clots. “The hope is that they’ll work as well as JAK inhibitors, without the risk for more serious side effects,” Zirwas says.
Larger studies of the drug are expected to start in 2027.
Better Biologics
The four biologics currently available to treat eczema target two chemicals in the body, IL-4 and IL-13. But a new novel biologic called rezpagaldesleukin (Rezpeg) focuses on a different mechanism. It works to stimulate your body’s T regulatory cells, a type of white blood cell in your body that helps regulate your skin’s immune response. “Patients with eczema have deficiencies in their T reg cells that make them more susceptible to inflammation that causes redness and itching,” Yu says.
Research shows that people with moderate-to-severe eczema who took rezpagaldesleukin for 12 weeks saw an over 80% reduction in their symptoms. But unlike other eczema medications, most were able to maintain these improvements nine months after they stopped treatment. “This could really be a game changer for people who struggle to afford out-of-pocket costs for biologics, or have trouble keeping up with regular injections,” says Paul Yamauchi, MD, PhD, a clinical assistant professor of dermatology at the David Geffen School of Medicine at UCLA. “Too often, patients are forced to stop treatment because of expense, side effects, or lack of access to health care, which then triggers a relapse.”
The company is now studying rezpagaldesleukin in people with moderate-to-severe eczema who have tried and not responded well to other biologics and JAK inhibitors. Results are expected in 2028.
There are other biologics being developed that target different inflammatory pathways, like IL-22. They may be options for people who haven’t responded to older biologics, Yamauchi notes. But these aren’t yet being studied in humans.
Fewer Side Effects
JAK inhibitors have several advantages over other medicines for moderate-to-severe eczema. These drugs tend to work very quickly, and you can take them every day by mouth, instead of an injection every two to four weeks.
But they also carry a lot of side effects, such as an increased risk of respiratory infections like colds and flu, headaches, and nausea. In very rare cases, you may develop blood clots, pneumonia, or tuberculosis.
A new type of JAK inhibitor, zemprocitinib, is targeted to a specific JAK inhibitor, JAK1. This means that it may be safer than older JAK inhibitors and not cause as many side effects. Initial studies suggest it works well to help ease moderate-to-severe eczema symptoms. But it’s still too early to tell how it compares to other drugs and whether it’s safer, Zirwas says.
A Gut Connection
Studies show there may be a link between your gut health and eczema. “We think that some people with eczema may have less good bacteria in their gut, which makes them more vulnerable to inflammation,” Zirwas explains. Researchers are studying whether a specific bacteria called Roseomonas mucosa can help improve eczema symptoms when it’s applied to the skin. Initial studies suggest it’s helpful, but larger ones need to be done too. “It’s thought that these sort of probiotic-based treatments will be used to help enhance moderate-to-severe eczema treatment, not replace it,” Zirwas stresses.
If you have moderate-to-severe eczema and you feel like your current treatments don’t help, talk to your doctor. They may be able to refer you to a clinical trial for a new therapy. You can also search on your own at the NIH government website here.
