Biologics for Atopic Dermatitis: Are They Right for You?

The U.S. Food and Drug Administration has approved four injectable drugs — dupilumab (Dupixent), tralokinumab-ldrm (Adbry), lebrikizumab-lbkz (Ebglyss), and nemolizumab-ilto (Nemluvio) — for the treatment of atopic dermatitis.

Dupilumab is approved for people as young as 6 months old, and tralokinumab-ldrm, lebrikizumab-lbkz, and nemolizumab-ilto are approved for people 12 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, lupus, psoriasis, 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 Dr. Vij.

In addition, more biologics for atopic dermatitis may be in the pipeline, he says.

In general, dermatologists classify moderate atopic dermatitis as symptoms on 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 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 milder atopic dermatitis — for example, symptoms that don’t affect very much of the 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 the 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 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,” says Vij.

Biologics for atopic dermatitis come in a prefilled syringe or pen you use to inject the medication 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 the 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, so you don’t inject the medication into already tender skin.

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 they are not only more effective, but 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-ldrm and lebrikizumab-lbkz include eye and eyelid inflammation and pain or swelling around the injection sites. Some possible side effects of nemolizumab-ilto include headache, hives, joint pain, and muscle aches.

A biologic doesn’t cure atopic dermatitis, but it could 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 says.

“Time will tell,” says Vij.