Key takeaways
- Biologic medications target specific proteins that cause inflammation. Your doctor may recommend a biologic if standard eczema treatments, such as steroid creams, aren’t providing enough relief.
- Biologics are given as subcutaneous injections. While they generally allow for more treatment flexibility than other medications, they can cause side effects such as pink eye, injection site reactions, and upper respiratory infections.
- The cost of biologic drugs can be high, but insurance may cover some or all of the expenses. It’s important to check with your insurer for specific coverage details.
Biologics are a relatively new treatment option for eczema, a condition that causes skin discoloration, dry patches, and intense itching as a result of an overactive immune response.
Unlike medications made from chemical compounds, biologics are targeted treatments made from living organisms. They can help treat eczema by targeting cytokines, the proteins that cause inflammation and eczema symptoms.
In the United States, about 31.6 million people (about 10% of the population) have some form of eczema. Not everyone who has eczema will need biologic treatment, but for those who do, four biologics currently have approval from the Food and Drug Administration (FDA).
The most common form of eczema is atopic dermatitis, and about 6.6 million adults in the U.S. have moderate to severe cases of the condition. Atopic dermatitis also affects 9.6 million U.S. children under 18 years of age, about one-third of whom have moderate to severe cases. Doctors may recommend biologics to treat moderate to severe eczema.
Your doctor will explain the available treatment options and help you choose the one that best suits your specific condition. Here are some questions and answers that may help.
Standard treatments for atopic dermatitis, such as steroid creams, may not be effective for every person. If you’re using creams and your symptoms are not improving or are getting worse, talk with your doctor as soon as possible.
They may recommend that you start using one of the four available biologic medications to better manage your eczema. These medications are:
Most initial treatments for atopic dermatitis are topical, which means you apply them directly to the affected area of your skin. They will work to manage irritation and inflammation only in that specific area.
Other older medications, such as oral or injectable disease-modifying antirheumatic drugs (DMARDs), can be used to treat eczema, but they suppress your immune system and can have long-term side effects.
Because biologic medications target the specific proteins that cause atopic dermatitis and generally allow for greater treatment flexibility, medical professionals may prefer them in some cases.
Each biologic comes with a risk of side effects. The table below shows some of the most common side effects for each medication.
| Medication | Possible side effects |
|---|---|
| dupilumab (Dupixent) | • injection site reactions • conjunctivitis (pink eye) • eyelid inflammation and dry eye • herpes simplex infections • keratitis (inflammation of the cornea) • itchy eyes • eosinophilia (high white blood cell count) |
| tralokinumab (Adbry) | • upper respiratory tract infections • pink eye • injection site reactions • high white blood cell count • inflammation of the cornea |
| lebrikizumab (Ebglyss) | • pink eye • injection site reactions • shingles (herpes zoster) |
| nemolizumab (Nemluvio) | • headache • joint pain • hives • muscle pain |
Talk with your doctor if you experience any of these side effects or any other symptoms you think may be linked to the medication. They will be able to offer the best advice on how to manage side effects and whether you need to change your treatment plan.
Response times may vary from person to person and from one biologic to another.
According to a 2021 research review, positive results have been reported after 2 to 16 weeks of treatment, depending on the specific drug.
You can take any of the four available biologics for eczema as a subcutaneous injection (an injection under your skin). These medications come in prefilled injector pens. Your doctor or another healthcare professional will teach you how to inject your medication.
You can use a biologic medication on its own or alongside topical steroid creams and some other medications. Your doctor will advise you on which approach is best for your specific situation.
If you miss a dose of tralokinumab (Adbry), lebrikizumab (Ebglyss), or nemolizumab (Nemluvio), take the dose as soon as possible and then resume your regular dosing schedule.
For dupilumab (Dupixent), depending on your age, your weight, or both, you’ll take the medication every 2 or 4 weeks. In either case, if you miss a dose, take the medication within 7 days of the missed dose and then resume your regular 2- or 4-week schedule.
If you don’t take the missed dose within 7 days, you should take a dose and then start a new 2- or 4-week schedule based on the date you took that dose.
Biologic medications are expensive because of the time and research required for manufacturing and testing. Without insurance, they can cost thousands of dollars per month.
Depending on your insurance plan, some or all of your medication costs could be covered. You can contact your insurance provider to check your specific coverage and find out whether prior authorization is necessary.
Also, some drug manufacturers offer savings programs that may help lower your medication costs. You can talk with your doctor about your medication options and contact the manufacturer of a specific medication to learn more.
Your healthcare team will consider your diagnosis, overall health, and preferences when forming your treatment plan for atopic dermatitis, which may include biologic medications.
When deciding whether to start biologic treatment, you may need to consider factors such as convenience, side effects, and cost. Be sure to ask your doctor any questions you have so that you understand your treatment options.