New treatments for eczema

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed skin. It can affect people of all ages, and managing it often involves a combination of treatments like biologic therapy to achieve better skin health and improved quality of life. This article provides an expert insight into the latest in biologic therapy for the treatment of eczema.

The landscape of eczema treatments

Historically, treatment options for eczema have varied widely, focusing mainly on symptom management rather than addressing the underlying causes of the condition.

Recent advancements in clinical research have led to the introduction of targeted treatment options for eczema that use the body’s own immune system to fight disease and infection. One such option is biologic therapy, or “biologics”, engineered proteins derived from biological (living) sources that target specific biological pathways in the body.

How does biologic therapy work for eczema?

In eczema, the immune system is often hyperactive, leading to the increased production of protein chemical messengers known as cytokines, which drive inflammation, signal skin cells to break down the skin barrier, and also cause itching.

Biologics for eczema work by blocking the action of a specific group of cytokines known as interleukins (ILs), which helps reduce the elevated immune system response. By calming the immune system, inflammation is reduced, resulting in fewer symptoms of eczema.

Biologics are still in the early stages of development and application in clinical practice. However, three have already received approval in the USA:

Dupilumab (Dupixent)

This was the first biologic approved for the treatment of moderate to severe eczema in adults and children aged six and above. It functions by blocking the signalling pathways of interleukin-4 (IL-4) and interleukin-13 (IL-13). In clinical trials, Dupilumab has been shown to reduce inflammation and improve the function of the skin barrier, helping alleviate eczema symptoms like itch.

Tralokinumab (Adbry)

This is a biologic approved for the treatment of moderate to severe eczema in adults. It works by inhibiting the IL-3 signalling pathway. In clinical trials, Tralokinumab has a demonstrated effectiveness in reducing skin lesions and itching and improving skin clearance.

Lebrikizumab

This is another biologic approved for the treatment of eczema in adults. It works by inhibiting the IL-3 signalling pathway. Clinical trial results suggest that Lebrikizumab can significantly improve eczema symptoms.

Who can benefit from biologic therapy?

Biologics are generally recommended for patients with moderate to severe eczema that hasn’t responded well to traditional treatments. This includes:

• Patients with frequent flare-ups
• Patients with severe itchiness and skin discomfort
• Patients seeking to avoid long-term use of corticosteroids

Biologics are administered via injection, typically once a week, depending on the specific drug and individual patient response. In most cases, they can be used in combination with topical treatments and emollients to improve overall management strategies.