Eczema: She couldn't even bend her fingers but a new treatment changed her life

Eczema can take its toll, but treatment-resistant patients are being offered hope. Photo / Getty Images

Holly McCammond woke up one morning with swollen, itchy eyes and rubbed them so vigorously she scratched her cornea, temporarily blinding herself and ending up in A&E. Thankfully, she didn't do serious damage, and it became just another episode in her lifelong battle with eczema, a painful and life-limiting condition she has endured since she was a toddler.

"For years, I rarely went out because my eczema was all over my face and neck and it made me feel so self-conscious," says McCammond, 24, from High Wycombe, England. She recalls her first day at primary school and the children not wanting to touch her, afraid they might "catch it".

Growing up, McCammond's daily skin routine was laborious; hours of slathering her body in steroid creams that would sting and burn before waiting for them to dry - and still suffering, even after all this effort.

"The eczema was incredibly painful but if it got infected, it would weep and smell - at times, I couldn't even bend my fingers because the open sores hurt so much," says McCammond, who works for an IT company. "Going to sleep was a constant struggle as I'd overheat, sweat and be desperate to scratch. I'd have fans and ice-packs and be constantly switching my bedding."

She adds: "Mentally, it was so difficult. There were times I felt so low I didn't know how much longer I could live like this. It was a fulltime job keeping on top of it and yet even when I did everything right, nothing changed. It felt so hopeless."

Eczema is a non-contagious, inflammatory dry skin condition that can affect people from early infancy to old age. Often appearing on the hands, inner elbows, knees and face, it is usually hereditary and there is no cure. The most common form, atopic eczema, affects one in five children and one in 10 adults in the UK.

"It's predominantly a genetic condition and down to the filaggrin gene, which causes impaired skin barrier function, giving you a tendency to develop it," said Dr Ophelia Veraitch, a consultant dermatologist at University College London Hospital (UCLH) and Harley Street.

"Triggers can include extremes in temperatures, stress and airborne allergens from dust mites, pets, grass or trees," she said. "Of course, we now have more pollution, more dust and lots of rubbish in the products we use on our skin, which could be contributing to the rise in cases."

First-line treatments include moisturisers and creams. For many, though, these are ineffective and stronger immunosuppressant medications are needed, such as methotrexate and ciclosporin, which inhibit inflammatory cells in the body; or phototherapy involving controlled doses of UV radiation to suppress the eczema.

And yet for some eczema patients, like McCammond, even these treatments don't work.

For these chronic sufferers, the arrival of three new medications - abrocitinib, upadacitinib and tralokinumab - which were given the green light by the National Institute for Health and Care Excellence (NICE) for patients over 12 earlier this year - has been a game-changer. Early indicators show they can significantly reduce severe eczema in a matter of weeks.

Abrocitinib and upadacitinib are known as JAK inhibitors and work by stopping the immune system from attacking the skin by blocking enzymes that help to activate the immune response. Tralokinumab is a monoclonal antibody drug which blocks the activity of proteins that trigger inflammation in the body.

Andrew Proctor, chair of the National Eczema Society, is thrilled these new treatments are now available, given the mental health impact of living with severe eczema long-term, with many patients experiencing sleeplessness, anxiety, depression and serious mental health problems.

"Eczema has such an impact on quality of life and can be brutal to live with," says Proctor. "We hear from many people who struggle to get through every day, so having these new treatment options is brilliant."

Dr Anthony Bewley, a consultant dermatologist at Bart's Health NHS Trust in London, knows the mental struggle too well, having suffered with atopic dermatitis as a young person.

"The psycho-social reality of living with eczema is profound as it affects your self-esteem and body image and then you have to deal with other people's reactions, with people saying hurtful things like, 'what's wrong with your hand?'" he said. "Some young people and adults get so fed up, they choose not to live and think of suicide."

Post-pandemic, with GPs overwhelmed and doing less face-to-face appointments, Bewley worries that the impact of eczema is at risk of being downplayed.

"25 per cent of GPs' consultations are skin-related, yet doctors have just two weeks of dermatology training in their undergraduate years and it's harder to pick up on the psycho-social impact in remote consultations. What we hear from patients is that the GP can say 'It's just your skin, it's only eczema' which makes them feel disempowered and wonder why they're bothering. But living with itching, skin pain and soreness has a huge impact on self-confidence and how you feel about yourself, and the consequent sleeplessness can affect work productivity and your ability to achieve your potential".

It was years of sleepless nights and pain that drove McCammond to sign up to a clinical trial she saw advertised on Facebook three years ago. "Within a month, I noticed it was working and there was no itching, pain or patches of eczema," she said.

McCammond was later told the two tablets she was taking daily were abrocitinib. "Looking at me now, you'd have no idea I have eczema. It's been life-changing. My confidence has grown so much. Before this treatment, I could never imagine a man getting close to me or touching me, but I met someone just as I started the treatment and he's now my partner and we live together."

Although the treatments have only been available for a couple of months, dermatologists are already seeing incredible results.

But there can be side-effects. The level of risk depends on the health of the individual patient. JAK inhibitors can alter your immune system's ability to react to pathogens, which is why these bacterial, fungal, or viral infections might be more prevalent.

More serious side-effects are increased risk of heart-related events such as stroke, cancer and blood clots - hence the need for regular blood tests and monitoring, especially in older patients. "These treatments are reserved for severe eczema patients who have gone through all the other options and exhausted them," says Dr Veraitch. "Patients need close monitoring with regular blood tests."

McCammond has been lucky and the treatment, so far, has been problem-free. "This is a game-changer for the world of severe eczema sufferers," she says. "And I'm so grateful."