Severe Childhood Eczema: What the TREAT Trial Compared
When a child's severe eczema disrupts school, play and family sleep despite topical care, a specialist may discuss medicines that work throughout the body. Two such medicines are methotrexate and ciclosporin, also spelled cyclosporine. The TREAT trial helps explain one comparison, while leaving room for an individual care plan.
Who took part?
In this randomized trial, published in 2023, 103 children and young people aged 2–16 with severe atopic eczema were assigned to ciclosporin (52) or methotrexate (51). Treatment lasted 36 weeks, followed by 24 weeks of observation after treatment stopped. This was a study of children needing systemic treatment; its results should not be generalized to every child with eczema.
What did researchers see?
| Question | Trial finding | What it means for families |
|---|---|---|
| Earlier response | Ciclosporin improved disease activity more quickly at 12 weeks. | Ask how soon the clinician expects to reassess symptoms. |
| After treatment stopped | Methotrexate showed more sustained disease control after withdrawal. | Discuss how follow-up and future flares will be managed. |
| Safety | Serious adverse events were reported in 5 of 52 and 7 of 51 participants, respectively. | These counts alone do not establish that the medicines caused the events or predict an individual child's risk. |
The trial did not compare these medicines with every newer option, and its modest size limits conclusions about uncommon harms. A 2026 research report describes the findings in more detail. Availability, licensed uses and prescribing practices vary by location.
Questions before a child starts treatment
- What makes systemic treatment appropriate for my child, and what alternatives should we consider?
- Which blood tests or other checks are needed, and when should we call about a fever or possible side effect?
- How should we handle missed doses, school trips, sports and medicine storage?
- How will we measure improvement, and when will we revisit the plan?
Follow the specialist's instructions exactly; do not change the medicine or schedule without asking the care team. Share the plan with the school nurse as appropriate. Our school-day eczema planning guide has more questions for families, and our article on protecting medicine from heat covers travel and sports days.
Everyday skin care alongside medical care
A clinician can explain how moisturizing fits alongside a child's treatment. Dr. Arsy Moisturizer #003 is a cosmetic moisturizer for dry, sensitive and eczema-prone skin; it is not a treatment for eczema and was not a treatment studied in TREAT.
Educational information only; a child's clinician can advise on the right plan.