Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition marked by dry, itchy, and often red or discolored patches of skin. While a range of treatments exists to manage its symptoms, individuals with more severe forms often find conventional therapies insufficient. Recent advancements have introduced biologics, a new class of treatments offering a targeted approach to managing persistent eczema by addressing the underlying causes of inflammation.
What Are Biologics?
Biologics are a unique class of medications that are developed from living organisms, such as cells, proteins, or antibodies. Unlike traditional drugs, which are typically small chemical molecules synthesized through chemical processes, biologics are large, complex molecules. Their intricate structure allows them to interact with specific targets within the body’s biological systems. This specificity is a defining characteristic, setting them apart from conventional small-molecule drugs like oral immunosuppressants or corticosteroids, which often have broader effects on the immune system.
Traditional small-molecule drugs are generally manufactured using chemical synthesis and can affect many different pathways in the body. In contrast, biologics are precisely engineered to target very specific components of the immune system that contribute to a particular disease. This targeted action aims to minimize off-target effects and reduce the likelihood of widespread side effects.
How Biologics Work for Eczema
Eczema is characterized by an overactive immune response that leads to chronic inflammation in the skin. This inflammatory process is largely driven by specific signaling proteins known as interleukins, which act as messengers within the immune system. Biologic therapies for eczema are designed to interfere with these precise inflammatory pathways. They achieve this by binding to specific interleukins or their receptors, thereby blocking the signals that lead to inflammation, itching, and skin barrier dysfunction.
For instance, several biologics target interleukins 4 (IL-4) and 13 (IL-13), which play a central role in type 2 inflammation in atopic dermatitis. Blocking these interleukins reduces inflammatory events and eczema symptoms. Another specific target is interleukin 31 (IL-31), directly linked to the sensation of itching. This targeted approach leads to a reduction in skin lesions and intense itching, often with fewer systemic side effects.
Current Biologic Medications for Eczema
Several biologic medications have received approval for the treatment of eczema, each targeting specific pathways involved in the disease. These therapies are generally administered via subcutaneous injection for moderate-to-severe atopic dermatitis, though age approvals vary.
Dupilumab (Dupixent): Targets the IL-4 and IL-13 signaling pathways. It is approved for use in individuals aged 6 months and older, helping to reduce inflammation and improve skin condition by blocking these key interleukins.
Tralokinumab (Adbry): Specifically targets IL-13, a cytokine heavily implicated in the inflammation of atopic dermatitis. It is approved for individuals 12 years of age and older and is given through subcutaneous injections.
Lebrikizumab (Ebglyss): Similarly targets IL-13. It is approved for individuals 12 years and older with moderate-to-severe atopic dermatitis, also administered via subcutaneous injection.
Nemolizumab (Nemluvio): Works by blocking the IL-31 receptor, directly addressing the itch pathway in eczema. It is approved for individuals 12 years and older with moderate-to-severe atopic dermatitis and is administered via subcutaneous injection.
Considering Biologic Treatment
Biologic treatments for eczema are considered for individuals with moderate-to-severe atopic dermatitis. These therapies are recommended when patients have not achieved adequate disease control with conventional topical treatments, or cannot tolerate them due to side effects. Initiating biologic treatment involves a thorough evaluation by a dermatologist or specialist, who assesses the condition’s severity and the patient’s medical history. This assessment ensures potential benefits outweigh associated risks.
Common side effects can include injection site reactions like redness, swelling, or itching. Some individuals may experience conjunctivitis or oral herpes. Upper respiratory infections have also been reported. These considerations are part of the discussion between the patient and their healthcare provider when determining the most appropriate treatment course.