Biologic Treatments for Eczema (Atopic Dermatitis)

Biologic treatments are a new option for people with moderate to severe eczema or atopic dermatitis.

Most people can control eczema with prevention techniques, topical treatments, or ultraviolet therapy. However, some people have severe eczema that isn’t adequately treated by these methods. If this applies to you, it might be worth considering a biologic type treatment.

This article discusses biologics for eczema, how they work, and how they are administered. It also talks about some of the potential side effects.

What Is Eczema?

Atopic dermatitis is the most common form of eczema. It is estimated to affect roughly 5% to 10% of adults in the United States and perhaps 10% to 13% of children.

Atopic dermatitis is what most people who are not medical professionals mean when they talk about “eczema.” There are, however, some other medical conditions that also have the word “eczema” in the name. One of these is seborrheic eczema, also called seborrheic dermatitis.

Eczema is not contagious. Eczema-like rashes can sometimes be caused by infectious microorganisms, however. These types of rashes are less common.

Symptoms of atopic dermatitis include:

• Dry and cracked skin
• Itchiness
• Redness

Sometimes symptoms can become so severe that the skin cracks and oozes.

Symptoms may wax and wane over time. If severe, the lesions may bleed and cause scarring. Painful symptoms can also interfere with your quality of life.

Researchers don’t fully understand the causes of atopic dermatitis. Both environmental and genetic factors seem to play a role. Many people with atopic dermatitis also have asthma or allergic rhinitis (nasal allergies).

People with atopic dermatitis may have a more fragile epidermis, the outer layer of skin. This results in abnormal contact between immune cells from deeper layers of the skin and substances in the external environment. This can cause the immune response that leads to eczema symptoms.

Some specific problems with a part of the immune system called the adaptive immune system probably also contribute to the disease. This is how biologic treatments can help.

Available Biologic Treatments

Biologic treatments are developed from some part of a living substance. They are different from traditional pharmaceutical drugs manufactured in a laboratory from non-living chemicals.

Biological treatments have recently become available for several conditions that affect the immune system. These conditions include:

• Rheumatoid arthritis
• Crohn’s disease
• Psoriasis (another skin condition)

These treatments have revolutionized the treatment of these diseases. In some cases, they can radically improve symptoms.

Dupixent (dupilumab)

Dupixent (dupilumab) was the first biologic treatment approved for atopic dermatitis. It became available in 2017.  It is currently approved for adults and adolescents 12 years and older with moderate to severe atopic dermatitis.

Adbry (tralokinumab-ldrm)

Adbry (tralokinumab-ldrm) was approved by the FDA in 2021. It is available for people 18 and older with moderate to severe atopic dermatitis.

Other Biologic Treatments Are Being Studied

Other biologic treatments for atopic dermatitis are currently being studied. Some of these treatments have similar immune targets as the currently approved options. Others work differently.

It is possible that some of these biologic treatments will be approved by the FDA in the future. For example, the biologics nemolizumab and lebrikizumab have completed successful phase two and/or three clinical trials.

Other biologic treatments are also under investigation. Eventually, there may be many different biologic treatment options for this condition.

Off-Label Biologics

In the past, some healthcare providers have prescribed “off-label” biologics for atopic dermatitis. Off-label treatments for atopic dermatitis haven't undergone the full set of clinical trials required for FDA approval.

There are FDA-approved biologic treatments for some inflammatory conditions like psoriasis. One of these is a TNF inhibitor called Enbrel (etanercept). Since psoriasis and atopic dermatitis have some of the same causes, it was hoped that medicines like Enbrel might also help with atopic dermatitis.

With the approval of Dupixent and Adbry, however, clinicians are less likely to prescribe biologics that have not been specifically FDA approved for the treatment of atopic dermatitis.

Dupixent and Adbry are FDA approved only for the atopic dermatitis form of eczema. It is possible, however, that healthcare providers might also prescribe these medicines off-label for other types of eczema.

How Biologics Work

Dupixent and Adbry are “monoclonal antibodies.” Unlike the antibodies your body produces in response to certain infections, Dupixent and Adbry are produced in a laboratory.

Dupixent blocks the actions of two proteins called interleukin-4 (IL-4) and interleukin-13 (IL-13). Adbry specifically targets interleukin-13 (IL-13). Both these immune system molecules are thought to play a role in triggering inflammation and symptoms of eczema.

Other biologics under development have been designed to target these immune pathways or similar immune pathways. For example, lebrikizumab is also designed to target the IL-13 pathway, while nemolizumab is designed to block interleukin-31. The idea is that blocking these proteins might decrease some of the immune activation that contributes to disease symptoms.

Treatment Alternatives

Biologics aren't usually a first-line treatment for eczema. This means that before starting one, your healthcare provider will want you to try other treatment options. These might include avoiding disease triggers and using emollients, which help keep the skin moist.

Some people can control their symptoms with topical corticosteroids or UV therapy. People with moderate to severe atopic dermatitis can also try topical medications called calcineurin inhibitors. Examples of these include:

• Elidel (pimecrolimus)
• Protopic (tacrolimus)

These are particularly useful in body parts where topical corticosteroids are generally avoided like the skin around the eyes.

Most people with eczema will respond to corticosteroids or calcineurin inhibitors and will not need a biologic.

There are also a number of non-biologic drugs that have been used off-label in the past. These have included:

• Neoral (cyclosporine)
• Azasan (azathioprine)
• Trexall (methotrexate)

Many people have to stop taking these medications because they can cause significant side effects. Biologics require less monitoring than these treatments, and they tend to have fewer side effects.

How Biologics Are Administered

Most biologic treatments cannot be taken orally. This includes Dupixent and Adbry.

Dupixent and Adbry are injected into the fatty area beneath your skin. Typically, these treatments are given every other week.

You may be able to administer these medications yourself. If so, your healthcare provider will give you specific instructions on how to do this.

Always clean and dry the area before injection. Never inject into an area that is scarred, tender, or otherwise damaged.

Be sure to follow carefully all storage and administration instructions. Biologic treatments are more sensitive than traditional drug treatments. Many need to be stored in the refrigerator. They may not work correctly if they are not handled and stored properly.

Can You Take Biologics with Other Treatments?

Ideally, you will be able to decrease the use of other medicines once you add a biologic. For example, you might be able to stop using steroid creams.

However, if needed, you can usually combine biologics with topical steroid creams. You may also still need to use topical calcineurin inhibitors on some body regions. As always, consult with your healthcare provider to make sure you understand your complete treatment plan.

Potential Side Effects

The safety of Dupixent is superior to the safety of long-term high potency topical corticosteroids. Calcineurin inhibitors also have a black box warning that Dupixent does not.

Like all treatments, though, biologics have possible side effects. Some of the more common problems with Dupixent, for example. are:

• Irritation at the injection site
• Infection with herpes simplex virus
• Eye problems such as blurred vision or eye redness, pain, dryness, or itchiness

Allergic reactions are also possible. In rare cases, these might be severe.

Other biologic treatments for atopic dermatitis, as they become available, may have somewhat different risks of side effects.

Precautions

Some people can’t take certain biologics safely. Your healthcare provider will consider your specific medical situation before prescribing this treatment.

Biologics may make you more likely to get certain types of infections. This means they might not be a good option for you if you have certain immune problems.

Caution should also be used in people who are pregnant or breastfeeding. These treatments have not been studied in this group of people.

Because of its impact on the immune system, you shouldn’t get the measles/mumps/rubella (MMR) vaccine while taking biologics for atopic dermatitis. You may need to talk to your healthcare provider about your vaccination history before starting the treatment.

Adbry isn't approved for people under the age of 18. Similarly, Dupixent isn’t currently approved for children under the age of 12. This is because these medications haven't been thoroughly tested in children. In some cases, however, your child's healthcare provider might recommend these treatments off-label.

Summary

Biologics are a relatively new treatment for people with eczema. They are prescribed for people with moderate to severe eczema who have not responded well to other treatments.

Biologics target certain proteins involved in the process of inflammation. At this time, only two biologics are available to treat eczema, but more may become available in the future.

Biologics are administered every other week. They are injected under the skin. Side effects may include irritation at the injection site or eye problems. You may be able to combine a biologic with other eczema treatments. 

A Word From Verywell

You and your healthcare provider will consider your situation to see if biologics might be a good fit for you. This will depend upon many factors, such as your other medical conditions, the severity of your disease, and financial considerations.

However, for many people, biologics are a good option especially if you haven’t been able to get your disease under control. If more biologic treatments eventually become FDA approved, you may have even more choices as to how to potentially address your disease.