For those patients who don’t get better with topical treatments or whose eczema covers much of the skin, systemic treatments are necessary. Light treatment (Narrowband UVB) is frequently used in psoriasis, and has been shown in some studies to be an effective treatment option for eczema as well. Light therapy is required two to three times a week until the eczema clears, and then long-term maintenance therapy is often required. Those with fair skin and blue eyes are at higher risk for long-term effects of light treatment. Unlike tanning salons, narrowband UVB has not been associated with increased risks of skin cancer. Traditional oral systemic agents for eczema such as cyclosporine, methotrexate, and mycophenolate have been used “off label”for decades to treat severe eczema in children and adults. These treatments may produce substantial improvement of eczema. However, these medications may have side effects such as bone marrow suppression, immune suppression, irritation of the liver, kidney damage and high blood pressure.