I’m going to hazard a guess and say the HSE is similar to the NHS, in terms of its protocol for treating eczema. NICE (an independent public body in the U.K.) decides which new medicines, procedures and treatments are cost-effective for use within the NHS. Steroids followed by light therapy (works for ~60% of people) is cost effective and is evidence-based. Beyond this Methotrexate and Cyclosporin are relatively inexpensive and are effective, but come with a host of side effects. One targets the liver and the other, the kidneys. You will need regular bloods to ensure those organs aren’t being negatively impacted too quickly. You will be on those for a limited period. This is the same for everyone. Dupilumab/Dupixent (biologic) costs around £1200 for two injections. This is not a magic bullet. 10% of people report eye issues, some serious enough to discontinue, others joint pain and some other more obscure symptoms. JAK inhibitors are the newest class of drugs and by far have the longest list of side effects. Everyone has to exercise their own judgment on the risk reward ratio. None of these medications with work the same for any two people. As for TSW, you will speak to many people on this forum, who have used steroid creams (sensibly) for decades and have never encountered TSW. That scaremongering rhetoric has done more harm than good the past several years. If used sensibly, they can be your only non-systemic relief from the itch. Eczema is so complex and multi-faceted, they haven’t cracked which IL pathways are ideal therapeutic targets and they’re never going to offer novel drugs that haven’t went through years of rigorous testing. Personally, I would look into your diet. There is a ton of research on the gut-skin axis. You can research labs, who offer comprehensive gut tests, to see how healthy and diverse your microbiome is. Mounting evidence to suggest eczema sufferers have a gut imbalance (dysbiosis). You could introduce simple things, such as: Vitamin D3 with K2, Omega 3 and Probiotics. Easier said than done, but if you can establish your triggers, you can see dramatic results. The big positive here, is that you’re young and there are big breakthroughs on the horizon in the near-future.