Severe Eczema Treatment Options in 2026

By Dr Kate DeAmbrosis

BMed. (Hons) (Newcastle) FACD Specialist, MPH, Dermatologist

In Australia, cornerstone to the treatment of moderate-to-severe atopic dermatitis (eczema) is skin barrier restoration and repair, with escalation to phototherapy and systemic agents if required. Foundational therapy remains as liberal application of emollients, trigger avoidance, and anti-inflammatory topicals (moderate to potent topical corticosteroids), with topical calcineurin inhibitors for sensitive sites and also for steroid-sparing maintenance. For more extensive and refractory eczema, narrowband UVB phototherapy is a common specialist option.

When topical therapy is inadequate or phototherapy is not a logistical option, systemic agents are indicated. Options now include targeted biologics and oral small molecules. Dupilumab (IL-4/IL-13 pathway) is TGA-registered for severe atopic dermatitis in children as young as 6 months and is widely used long term given its safety profile. Lebrikizumab is an IL-13 monoclonal antibody approved by the TGA, but not currently subsidised by the PBS, meaning patients must get it via private prescription at an out of pocket cost.

Oral JAK inhibitors provide rapid itch and inflammation control for suitable patients:  upadacitinib, baricitinib and abrocitinib are TGA-registered options. Additional systemic immunomodulators (eg. Cyclosporin; methotrexate) may be used in selected instances under specialist dermatologist care.