How does the drug work?
It inhibits janus kinase (JAK).
JAK involves cytokines informations conveyance within cells, so JAK inhibitors can reduce local overimmunity, inflammations and itches.
Oral JAK inhibitors have already been used for severe cases of Rheumatic Arthritis and Ulcerative Colitis for several years, but this is the first release as a topical one.

For AD, a marvelously effective injection Dupilmab, sold as Dupixent, has been added recently.
Dupilumab is an monoclonal antibody against alfa subunits of interleukin 4 receptors.
It costs very high but inhibit causative signals mediated by interleukin 4/13, thus drastically resolves skin inflammations and barrier dysfunctions of AD.
Indications of Dupilumab are limited to the severest AD.
And the patients still have to continue topical corticosteroids, tacrolimus and moisturizers/emollients throughly along with the periodical injections.

Delgocitinib does not have such strict regulation, maybe because it is just topical.
In clinical trials before the approval, it was tried to medium to severe cases of AD.
However, the direction and dosage of the drug are a little limiting.
Patients should not apply over 5g at a time. They can put two times a day.
If a sufficient effectiveness is not seen within four weeks, they should stop it.
And when they got the improvement, prolonged use should be avoided.
So, delgocitinib will not be an everyday drug, unlikely topical corticosteroids or tacrolimus.
It implies delgocitinib contains certain unfavorable risks.

The most obvious risk is, of course, infections.
These new drugs can suppress a singular point which relate to the target disease among huge complex human immune systems.
But the immunity naturally should work to protect our bodies from foreign attacks.
It’s no wonder if some portions of immune systems cease to work, the original eliminating function against intruders would be impaired in various degrees.
Those antibody therapeutics, often characterized by the name of xxxmub, are destined so.

The patients with xxxmub are deprived of their original ability to confront numerous bacterias, viruses, molds and fungus.
Oral herpes, Kaposi’s varicelliform eruptions, shingles, folliculitis… they are apt to be defeated by many infectious pathogens.

Such drugs might also induce cancers and/or autoimmune disorders in a long term.
Because the essential eliminating process of innate foreigners, especially mutant cancer cells will be disabled, too.
Moreover, repeated injection of foreign antibodies may be cautiously memorized by immune systems, forming anti-drug antibody, which may either weaken the effectiveness, or cause severe allergic reactions to the drug.
Patients’ lives might be shortened… Should they accept it?

Though dupilumab are indicated for adult AD and athma ages 12 and over for now, delgocitinib trials for children AD are already moving on.
Delgocitinib ointment will be another revitalizing measure for uncontrollable, but not the severest AD, including children and adults patients.

I am a dermatologist and an AD patient, too.
I think I should be fully aware of these new drugs in dermatologic field, however I still dream more natural healthcare with minimal drugs.
Actually, I can manage my AD with only vaseline on my hands.

I provide alternative medicines in Adachi Clinic.
Those resources are Numbudripad Allergy Elimination Techniques (NAET) and Chiropractic.
On the other hand, I prescribe topical and oral alleviation medicines in a hospital.
Which treatment do you want to manage yourself?
You choose your decision.

2020.03 (translated in 2020.07)