They may not know each other, but they have something very much in common. For as long as they can remember, Kwame Baird from New York City and MaryPat Weir of Ramsey, New Jersey have suffered with eczema. The painfully itchy rash disrupted their sleep, and left each of them feeling frustrated and demoralized.
Both are also teachers, who had to get used to answering questions from curious kids about what was wrong with their skin.
For decades, they had used topical steroids and periodic oral steroids. But nothing brought lasting relief.
That changed after they began taking a new medication, upadacitinib (the brand Rinvoq) as part of a clinical trial. The daily pill is among a new class of eczema drugs which recently gained U.S. Food and Drug Administration approval. Dermatologists say the powerful drugs, known as JAK inhibitors, are the most effective medications for atopic dermatitis (or eczema) introduced in decades.
JAK inhibitors block the action of a family of enzymes, Janus kinases (JAKs). These enzymes are involved with messaging on a pathway among immune cells and cytokines, which are molecules that kick off inflammation and itch. By disrupting JAK messaging, the medications suppress cytokines, reducing eczema symptoms.
The FDA approved three JAK inhibitors for eczema: upadacitinib and abrocitinib (Cibinqo), both once-daily pills, and ruxolitinib (Opzelura), a skin cream.
The pills are recommended for people with more severe eczema that is not well-controlled with other oral or injectable eczema medications. Upadacitinib is okayed for adults and children ages 12 and up; abrocitinib is for adults only. The cream is aimed at mild to moderate eczema, and approved for adults and children 12 and up.
Kwame Baird’s Story
Some of Kwame Baird’s earliest memories are of taking oatmeal baths and slathering on lotions and ointments to soothe his painfully itchy skin. “As a kid, I thought it was normal for people to itch or scratch all the time,” says Baird, who’s 39. In middle school, “when I compared my skin to other kids, it was discolored and patchy.” That was when “I started to realize my skin was different,” he says.
When he went away to college, Baird’s eczema got worse. He wore gloves at night to try to stop himself from scratching in his sleep and waking up with raw and bleeding skin.
“There were days when I was scratching myself so bad, I could hardly walk from all the aches,” he says. “I carried on like that, itching all the time.”
He sought treatment, but “every doctor would tell me the same thing: ‘Try not to get too dry. Try not to sweat too much. Use a prescription steroid. Don’t use it for too long. Just use it in spots for a couple of weeks and then leave it alone.’”
The pain and itch would improve temporarily, only to come roaring back when he stopped using the creams and oral steroids. Baird enrolled in a clinical trial for an injectable eczema medication, but for him, there was no benefit.
As a father with two young children and a high school English teacher in the Bronx, Baird started worrying about how he would continue to cope with eczema’s misery. As a result of his cracked skin, he got a serious skin infection that sent him to the hospital.
A dermatologist recommended that he enroll in the New York clinical trial for upadacitinib, being led by Dr. Emma Guttman-Yassky, chair of dermatology and immunology at the Icahn School of Medicine at Mount Sinai. After a month on the medication, Baird’s itch was much better. Three months later, he wasn’t itching at all. The bumps and patches on his skin began to clear.
Baird started wearing short sleeves and bright clothes, which he had long avoided because of his flaking skin. “The biggest thing is the mental health,” he says. Freed from the itch, he realized what a burden the condition had been.
“Maybe every once in a while, I feel a little bit of an itch, but it goes away when I put on some cream or lotion.” Being on the JAK inhibitor, “has completely changed my life.”