Eczema can be managed with certain self-care regimens, such as fragrance-free soap, brief lukewarm baths or showers, and regular skin hydration with a strong emollient like CeraVe cream or Vaseline. Over-the-counter products, such as topical hydrocortisone cream, can also be helpful.
However, these tools sometimes aren’t enough, and you may need help from a dermatologist (a doctor who specializes in skin conditions) to keep your skin healthy and comfortable.
My husband, my 10-month-old daughter, and I have eczema, so I have experience with this chronic skin condition. If your eczema symptoms interfere with your life, such as making it difficult to concentrate at school or work or sleep through the night because of intense itching, then that’s a sign you may need to see a dermatologist.
Untreated eczema can cause many problems, including impetigo (a skin infection caused by bacteria entering your skin after scratching) and cognitive issues among children, such as learning disabilities, memory problems, or attention deficit hyperactivity disorder (ADHD).
Since eczema can be managed effectively with the support of a dermatologist, you don’t have to endure these complications and be uncomfortable in your own skin.
If your eczema is severe enough to warrant the use of a biologic, then you’ll most likely need lifelong treatment. There’s no cure for eczema.
Most people with eczema benefit from the intermittent use of:
- phototherapy
- topical or oral steroids
- nonsteroidal medications, such as methotrexate, azathioprine, or mycophenolate mofetil
Biologic agents, such as dupilumab (Dupixent) or lebrikizumab-lbkz (Ebglyss), are reserved for people who have tried these therapies yet haven’t found any relief from their symptoms. Some people are able to achieve relief after about 16 weeks of biologic treatment and can attempt a trial period off the medication.
The main concern is that people can develop antibodies to the biologic; therefore, when it’s reintroduced into the body again during a future eczema flare, the biologic medication may not work again. For this reason, certain dermatologists recommend people with severe eczema stay on a biologic long-term.
However, some people do OK after taking a break from a biologic. So, this is really a highly individualized experience.
Every person is different and will respond to a biologic medication at their own pace.
Most people typically notice some improvement in their eczema symptoms within a couple of weeks to months of starting a biologic medication.
Some people who are prescribed a biologic will notice less itching in as little as 2 weeks from starting treatment. In various clinical trials, the majority of people will notice an improvement in their eczema symptoms within 16 weeks of starting biologic treatment.
Several studies have shown that biologics show continued improvement for patients who stay on the drug for more than 4 years, even when they reduce their dose from weekly to every other week.
Since biologics used to treat eczema are relatively new. Ongoing research is needed to determine whether these medications eventually lose their effectiveness. In addition, some people can develop antibodies to a biologic, which will also reduce their efficacy.
Some dermatologists are hesitant to stop a biologic in people with severe eczema who have no other effective treatment options. The experience of chronic eczema varies significantly from person to person.
How a drug works in your body will depend on your genetics, immune system, environmental factors, and eczema severity, among other factors.
Biologics are often used to treat moderate to severe eczema when other treatments haven’t worked.
Four biologic medications have been approved by the Food and Drug Administration (FDA) to treat eczema. They all work on various proteins called cytokines that promote the inflammation that drives eczema.
- Dupilumab (Dupixent) is the first FDA-approved biologic to treat eczema. It can be used to treat severe eczema in people 6 months to 11 years old or moderate to severe eczema in people 12 years and older. It blocks the cytokines interleukin-4 (IL-4) and interleukin-13 (IL-13).
- Nemolizumab-ilto (Nemluvio) is FDA approved to treat moderate to severe atopic dermatitis in people 12 years and older. It works by inhibiting the signaling of interleukin-31 (IL-31).
- Lebrikizumab-lbkz (Ebglyss) is FDA approved to treat moderate to severe atopic dermatitis in children and adults 12 years and older who weigh at least 88 pounds (40 kilograms). It works as a targeted IL-13 inhibitor.
- Tralokinumab-ldrm (Adbry) is FDA approved for the treatment of moderate to severe atopic dermatitis for people 12 years and older. It works by blocking IL-13 from binding to its cell surface receptors (IL-13R alpha 1 and IL-13R alpha 2).
Dr. Joan Paul is an ABMS board certified dermatologist who specializes in psoriasis, skin cancer, skin of color, and global health. She has also completed seven medical missions in the countries of Haiti, Trinidad & Tobago, Mexico, Malawi, Uganda, India, and Botswana.