Biologic Treatments for Eczema (Atopic Dermatitis)

New Treatment Option for Moderate to Severe Disease

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Biologic treatments are a new option for people who suffer from moderate to severe atopic dermatitis (a kind of eczema). In most people, eczema can be controlled 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.

What are Eczema and Atopic Dermatitis?

“Eczema” refers to a group of non-contagious medical conditions that cause skin inflammation. Eczema is more formally known as “dermatitis,” meaning inflammation of the skin.

The most common form of eczema is atopic dermatitis. This is what most non-medical professionals mean when they talk about “eczema.” However, there are some other medical conditions that also have the word “eczema” in them, such as seborrheic eczema (also called seborrheic dermatitis).

Atopic dermatitis is a very common inflammatory skin disorder, estimated to affect roughly 5 percent to 10 percent of adults in the U.S. and perhaps 10 percent to 13 percent of children. It causes skin symptoms like dry and cracked skin, itchiness, and redness. When severe, the lesions may bleed and lead to scarring.

Symptoms may wax and wane over time. If severe, symptoms can interfere with people’s quality of life as well. Many people with atopic dermatitis also have asthma or allergic rhinitis.

Researchers don’t fully understand the causes of atopic dermatitis, but both environmental and genetic causes seem to play a role. People with atopic dermatitis have a genetic susceptibility to having a more fragile layer of outer skin (the epidermis). This results in abnormal contact between immune cells from deeper layers of the skin and substances in the external environment.

Some specific problems with a part of the immune system (the adaptive immune system) also probably contribute to the disease. These alterations to the immune system may be targeted for interventions via biologic treatments.

Biologic Treatments Available for Atopic Dermatitis

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

In recent years, biological treatments have become available for several different medical conditions that affect a person’s immune system and immune response. These include rheumatoid arthritis, Crohn’s disease, and psoriasis (another skin condition), among many others.

Biologic treatments are designed to provide targeted treatment to a specific component of a person’s immune system.

These treatments have revolutionized the treatment of these diseases, in some cases radically improving people’s symptoms.

Dupixent (Dupilumab)

In 2017, the U.S. Food and Drug Administration (FDA) approved the first biologic treatment for atopic dermatitis: Dupixent (dupilumab). Currently, Dupixent is the only biologic treatment for atopic dermatitis approved by the FDA.That means the drug has been thoroughly tested for safety and effectiveness in clinical trials in humans, including the phase three clinical trials needed for approval. It is currently approved for adults and adolescents (12 years and above) with moderate to severe atopic dermatitis.

Other Biologic Treatments Are Being Studied

Other biologic treatments for atopic dermatitis are currently being scientifically studied. Some of these treatments have similar immune targets as Dupixent, and others work slightly differently.

It is possible that some of these biologic treatments will be approved by the FDA in the future. For example, the biologics nemolizumab, lebrikizumab, and tralokinumab have all completed successful phase two clinical trials. Other biologic treatments are under investigation as well. Eventually, there may be many different biologic treatment options for this condition.

Off-Label Biologics

In the past, some physicians have also prescribed “off-label” biologics for atopic dermatitis. This refers to treatments that have not undergone the full set of clinical trials required for FDA approval for atopic dermatitis, but ones that clinicians believe still might help.

Some inflammatory conditions already have had FDA approved biologic treatments (such as psoriasis). It was hoped that some of these treatments might also help with atopic dermatitis, since there is some overlap in their underlying causes. For example, in the past some doctors have prescribed TNF inhibitors like etanercept (a drug approved for psoriasis) to people with atopic dermatitis.

However, with the approval of Dupixent (and potentially other biologics in the future), clinicians will probably be less likely to prescribe biologics that have not been specifically FDA approved for the treatment of atopic dermatitis. It’s possible that clinicians might also prescribe Dupixent off-label for other types of eczema, even though officially it is FDA approved only for the atopic dermatitis form of eczema.

How Biologics for Atopic Dermatitis Work

Dupixent is a type of “monoclonal antibody.” Unlike the antibodies your body normally produces in response to certain infections, Dupixent is produced in a laboratory. It is made to target a specific type of receptor found on certain immune cells, called interleukin 4 (IL-4).

This blocks the downstream signaling of two immune system signaling molecules: interleukin 4 and interleukin 13. Both of these immune system molecules are thought to play a role in triggering inflammation and symptoms of the disease. So by blocking these signals, the treatment may work to decrease your symptoms.

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

Treatment Alternatives for Atopic Dermatitis (Eczema)

Before starting a biologic, you’ll probably attempt to try to control your disease using other methods. These might include prevention techniques, to avoid disease triggers. Emollients, used to keep the skin moist, are also a cornerstone of therapy.

Some people can also get their disease under control with steroid creams, or with UV therapy. Another option for people with moderate to severe atopic dermatitis is a type of skin cream called calcineurin inhibitors (such as pimecrolimus and tacrolimus).

On the whole, it is worth trying these approaches, since they may not carry the same risks as biologics. They also will probably not be as expensive as biologics. But they may not fully get your disease under control.

There are also a number of non-biologic drugs that have been used off-label in the past. These have included the drugs cyclosporine, azathioprine, and methotrexate. But these alternatives don’t work for a lot of people. Many people have to stop taking them because they can cause significant side effects. Biologics require less monitoring than these treatments, and they tend to have fewer side effects.

How Biologics for Eczema Are Administered

Most biologic treatments cannot be taken orally. This includes the FDA approved biologic treatment Dupixent. Typically, the treatment is given every other week.

Dupixent is given as an injection into the fatty area beneath your skin. Your healthcare provider will give you specific instructions about how to administer it.

Most people are able to give themselves the injection after they learn how. The injection is typically given into a fatty area around the belly or thighs.

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

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

Can I Take Biologics with Other Treatments?

Ideally, you will be able to decrease the other treatments that you need if you add a biologic. For example, you might be able to stop using steroid creams on your skin.

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

Potential Side Effects

Like all treatments, biologics have possible side effects. Some of the more common problems with Dupixent 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-type reactions are also possible, which in rare cases might be severe.

If you experience reddish welts on your skin after taking the treatment, contact your health care provider immediately. Also seek immediate medical attention if you have any serious medical symptoms, like difficulty breathing.

As more biologic treatments for atopic dermatitis become available in the future, they may reveal somewhat different risks of side effects.

Precautions in Using Biologics for Atopic Dermatitis

Some people can’t take certain biologics safely. You and your doctor will consider your specific medical situation before prescribing the treatment. Biologics may make you more likely to get certain types of infections, so they might not be a good option for you if you have certain immune problems.

Caution should be used in women who are pregnant or breastfeeding, as the treatment has not been studied in this group of people.

You also won’t be able to get certain kinds of vaccines (called “live” vaccines) while taking biologics. Because of its impact on the immune system, you shouldn’t get the measles/mumps/rubella (MMR) vaccine while taking Dupixent. You may need to talk to your doctor about your vaccination history before starting the treatment.

Dupixent isn’t currently approved by the FDA for children under the age of 12. It hasn’t been thoroughly tested in children younger than this. However, in some cases, your doctor might recommend the treatment in a younger child, as an off-label application.

A Word from Verywell

You and your doctor 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.

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Article Sources

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