Biologics are some of the newest treatment options for atopic dermatitis. Biologics have been around for years as treatment options for many conditions that affect the immune system, but the FDA didn’t approve them for treating atopic dermatitis until 2017.
Biologics work differently than other atopic dermatitis treatments. Instead of treating general inflammation all over your body, they target specific molecules. Scientists modify the genes of bacteria and cells in a lab and use those living organisms to make biologic drugs.
The FDA has approved these four biologics to treat atopic dermatitis: dupilumab, lebrikizumab, nemolizumab, and tralokinumab. They are all types of biologics called monoclonal antibodies. Biologics are monoclonal antibodies that have a name that ends with -mab.
How Biologics Work
Monoclonal antibodies are a type of protein researchers make in a lab to mimic your body’s natural antibodies. Antibodies are part of your immune system. They identify substances that shouldn’t be in your body and force other parts of your immune system to destroy them or block them from getting certain signals.
The way antibodies find these foreign substances is by seeking out certain proteins on the surface of the substance.
Once researchers figure out a specific antigen to target – such as one involved in atopic dermatitis symptoms – they can create monoclonal antibodies that fit these antigens and help treat the symptoms.
Dupilumab and tralokinumab treat atopic dermatitis by targeting chemical messengers called interleukins (ILs). ILs help turn on the inflammation process in your body. Both drugs block receptors on your cells so that certain ILs can’t attach to them.
It’s as if these biologics cover up a keyhole (the cell receptor) so a key (the IL) can’t go in and start the ignition that would turn on the car (inflammation).
Dupilumab
Dupilumab (Dupixent) is a biologic approved for people ages 6 months and older, if your atopic dermatitis cannot be controlled with topical creams. You need a prescription to get it. You give it to yourself as an injection under the skin every other week or once a month. Your doctor will prescribe either a prefilled syringe or a pen with the correct dose in it.
You can’t take it in pill form because your digestive system would break it down and it wouldn’t work.
Dupilumab keeps your immune system from overreacting by targeting IL-4 and IL-13. These ILs also play a part in how well your skin works as a barrier. By blocking them, dupilumab helps strengthen your skin’s ability to protect you from germs and irritants.
The most common side effects include:
- Pink eye (conjunctivitis)
- Infection where the needle went in your skin
- Cold sores on your lips and in your mouth
Tralokinumab
Tralokinumab (Adbry) is the newest biologic option for treating atopic dermatitis. The FDA approved it in December 2021. This biologic targets IL-13 only. It works similarly to dupilumab, blocking IL-13 so it doesn’t turn on the inflammation process.
You inject it under your skin every other week. Children aged 12 and up and adults can take it. This is also if you have moderate to severe eczema.
Side effects include:
- Upper respiratory tract infections
- Pink eye
- Infection where the needle went in your skin
Because biologics are targeted therapies and don’t go through your whole system, they tend to cause fewer side effects than other treatments. You can use topical treatments in combination with both dupilumab and tralokinumab.
Lebrikizumab
Lebrikizumab (Ebglyss) is another biologic that was approved by the FDA for moderate to severe atopic dermatitis in September 2024. It works by targeting IL-13, which causes inflammation, itch, and skin damage. It can be taken by adults and children 12 years and up.
Side effects include:
- Eye problems, including redness or swelling
- Burning or dryness in eyes
- Pain or redness where the needle went in
Nemolizumab
Nemolizumab (Nemluvio) is a biologic that was approved by the FDA in December 2024. It is injected under your skin. It works by blocking IL-31. It is also prescribed for a skin condition called prurigo nodularis, which looks like itchy, raised bumps.
Side effects include:
- Cracked, scaly skin
- Hives
- Headaches
Who Should Take Biologics for Atopic Dermatitis?
Most people can treat their AD with prevention, topical treatments, UV therapy, and by maintaining skin care. Doctors typically wait to prescribe biologics until after you’ve tried other treatment options for AD or have severe AD.
Often they’ll want you to have tried at least one immunosuppressive drug first. If that treatment doesn’t work, biologics may be the best treatment for you. Some people can’t take immunosuppressive drugs because of the side effects, so biologics make more sense as a treatment.
Although dupilumab is OK for kids as young as 6 months, doctors may only go that route if the child’s AD is severe. After 12 years, doctors will consider it for moderate cases.
Doctors usually look at how much of your skin is affected and how intense your symptoms are to figure out whether you have mild, moderate, or severe AD. Along with skin symptoms, they’ll need to know how your AD impacts your life. If it’s getting in the way of your daily activities, even if it doesn’t affect a lot of your skin area, you may need a biologic to help keep it under control.
Who Shouldn’t Take Biologics for Atopic Dermatitis?
There are a few reasons your doctor might not recommend a biologic for your AD treatment or suggest you wait to try it at another time. These include:
- You’re scheduled for a live vaccine. Because biologics have an impact on your immune system, you shouldn’t get any live vaccines while taking them.
- You’re pregnant or breastfeeding. There’s not much information yet about how biologics might affect breast milk or unborn babies.
- You have an allergic reaction to them. If you get a rash, have trouble breathing, or other symptoms of an allergic reaction, tell your doctor.
