The Consumer’s Guide to Biologics for Atopic Dermatitis
Everything you need to know about this new treatment for eczema, including whether it may work for you.
M ore than 16.5 million adults in the United States have atopic dermatitis, a common form of eczema that often causes flare-ups of dry, itchy, discolored patches of skin. It particularly affects the insides of the elbows and knees, as well as the hands, feet, and face, according to the National Eczema Association. Here's what you should know about this new medication.
How Current Biologics Work in the Body to Fight Atopic Dermatitis
In medical speak, biologics are very targeted medications, meaning they work by homing in on specific molecules in the body responsible for triggering inflammation, says Alok Vij, MD, director of the dermatology residency program at Cleveland Clinic and an associate professor of dermatology at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.
“As a dermatologist, it is exciting to see new medicines come to market for atopic dermatitis,” says Dr. Vij. “These medications empower us to work with people who have the condition to find the best solution to reduce the burden of their symptoms.”
How Other Atopic Dermatitis Medications Work
“Biologics have revolutionized the treatment of several dermatologic disorders,” says Shawn Kwatra, MD, director of the Johns Hopkins Itch Center in Baltimore, because they work by targeting particular molecules in the body, rather than lowering inflammation in a broad manner, as other medications do. Here’s a brief guide to some of the other common atopic dermatitis treatment options on the market.
- Topical hydrocortisone, a low-strength steroid that’s sold over the counter, is available as an ointment, cream, lotion, or gel that’s applied directly to the skin.
- Topical corticosteroids, which are also applied to the skin, can help quell inflammation and itching. They’re available by prescription in different strengths, with the potency levels ranging from very potent (Class 1) to least potent (Class 7).
- Immunosuppressants — as their name suggests — suppress the immune system more broadly, tamping down the inflammation that triggers symptoms like itching and irritation.
- Phototherapy, or light therapy, uses different wavelengths of ultraviolet light to treat atopic dermatitis.
5 Essential Facts About Biologics for Atopic Dermatitis
1. There are two injectables, dupilumab (Dupixent) and tralokinumab-Idrm (Adbry), approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis.
Dupilumab is approved for people as young as 6 months old, and tralokinumab-Idrm is approved for people 18 or older.
Many other types of biologics have been available for decades, though, including ones that have been approved for a wide range of chronic inflammatory conditions, including Crohn’s disease, psoriasis, lupus, rheumatoid arthritis, and more.
As researchers have learned more about the body’s inflammatory system and all the complicated pathways that can trigger inflammation, more biologics have been developed, says Vij.
In addition, more biologics for atopic dermatitis may be in the pipeline, he says.
2. Biologics are normally prescribed for people with moderate-to-severe atopic dermatitis.
In general, dermatologists classify moderate atopic dermatitis as an outbreak of symptoms that affects about 10 percent of the surface area of the body, says Vij, while severe atopic dermatitis affects 30 to 40 percent or more.
Not sure how much of your body is affected? Here’s a rough way to estimate the number: “The size of your palm is about 1 percent of your skin, so you count up the number of palm-sized areas that are affected,” says Vij.
People with more mild atopic dermatitis — for example, symptoms that don’t affect very much of their body and aren’t too bothersome — may be able to treat the condition with moisturizers or topical steroids during a flare, he says.
That said, there’s no magic formula for determining whether your condition is mild, moderate, or severe, which is why dermatologists also take other factors into consideration.
“It’s also about the global burden of atopic dermatitis on someone’s quality of life,” says Vij. For example, if your atopic dermatitis affects only a small area of your body, but that area is critical, such as your face, then you may want to consider a stronger medication, he says.
“If people are having problems at school or work or with their relationships, whether it’s normal friend relationships or sexual relationships, then we know their skin is having a greater cumulative effect than what you can just see,” Vij says.
3. Biologics are administered via an injection you can give yourself.
Biologics for atopic dermatitis come as a prefilled syringe or pen that can be injected into the skin. Your doctor will tell you how much medication to use and show you how to inject it. You may have to give yourself more than one injection, depending on your dosage.
You can inject yourself on the front of your thigh or on a part of your stomach that’s at least 2 inches away from your belly button. You’ll want to choose a different area each time you inject yourself, so you don’t inject already tender skin.
4. Biologics for atopic dermatitis seem to be safe, although there can be some side effects.
Because biologics don’t suppress the immune system more broadly — as immunosuppressants do — they’re less likely to trigger side effects, says Dr. Kwatra. In fact, because biologics work in such a targeted and specific way, the hope is that not only are they more effective, but they can also minimize other side effects, he says.
Right now, it seems there aren’t very many side effects with the biologics approved for atopic dermatitis, says Vij, but in some people, dupilumab can cause conjunctivitis (pink eye) or pain or swelling around the injection site. Some possible side effects of tralokinumab-Idrm include eye and eyelid inflammation and pain or swelling around the injection sites.
5. You may have to stay on the biologic for as long as it continues to work.
A biologic doesn’t cure atopic dermatitis, but it can treat the condition for as long as you keep taking it, says Kwatra. “Once you start it, it’s usually a continuous treatment,” he says.
That said, there’s always a chance that the biologic may become less effective over time, although it’s too early to tell whether this is the case for the current biologics. (Dupilumab, the first biologic approved for atopic dermatitis, has only been on the market since 2017.)
“We know that, with other biologics, people develop antibodies to the medication,” says Vij, which diminishes the effect of the medication. It’s also possible — though not certain — that stopping and starting the medication could have the same effect, he explains.
“Time will tell,” he says.
5 FAQs About Biologics for Atopic Dermatitis, Answered
Who Is a Candidate for a Biologic?
Next Steps: Making Atopic Dermatitis Treatment Decisions
You’ve learned a lot about biologics for atopic dermatitis, but how do you decide whether they’re right for you?
Before your next doctor’s appointment, ask yourself the following questions:
- Am I in remission (meaning your eczema flares are currently under control)?
- Have I experienced a resurgence of symptoms since starting my current treatment?
- Am I satisfied with my current atopic dermatitis treatment?
- Is my atopic dermatitis interfering with my quality of life? (For example, is your condition causing you to feel anxious or depressed?)
Keep these questions on hand to use at your next doctor’s appointment.
- What else can I do to ease my symptoms?
- Am I a good candidate for a biologic, or is there another medication I should consider?
- What results can I expect from this medication?
- How soon will I experience some progress on this medication?
- How long will I need to use this medication?
- How long can I expect to stay in remission?