Eczema Systemic Therapy — SCE Dermatology MCQ

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ModerateInflammatory DermatosesEczema Systemic TherapySCE Dermatology

A 30-year-old woman with moderate atopic eczema not adequately controlled with topical therapy is being considered for systemic treatment. According to NICE, what is the recommended first-line systemic immunosuppressant for atopic eczema?

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Correct answer: E — Ciclosporin (recommended as first conventional systemic for rapid control)

Ciclosporin is the only conventional systemic immunosuppressant with NICE/MHRA marketing authorisation specifically for atopic eczema, making it the recommended first-line conventional systemic. It provides rapid onset of action (2-4 weeks) which is advantageous for severe flares. Standard dosing is 3-5 mg/kg/day. Duration is typically limited to 1-2 years due to nephrotoxicity risk with prolonged use. If Ciclosporin is inappropriate (contraindications, intolerance), Methotrexate, Azathioprine, or Mycophenolate are used off-label. For patients failing conventional systemics, biologics (Dupilumab, Tralokinumab) and JAK inhibitors (Baricitinib, Upadacitinib, Abrocitinib) are available.

Reference: NICE CG57; BAD 2020 AD