Biologics for Atopic Dermatitis: Current Impact and Future Outlook

Biologics and targeted monoclonal antibodies have transformed the medical management of atopic dermatitis, shifting treatment away from broad immunosuppressants toward precision therapies that target specific molecular drivers of inflammation and itch, according to medical experts cited by Medscape Medical News.

Before the United States Food and Drug Administration approved the first biologic for atopic dermatitis in 2017, systemic treatment options were largely limited to broad immunosuppressive drugs, which often carried significant cumulative toxicity and limited effectiveness, according to a review published in PMC. Atopic dermatitis is one of the most common chronic inflammatory skin diseases worldwide, affecting roughly 4% to 8% of adults and 10% to 15% of children. Between 5% and 20% of patients experience severe disease activity that requires systemic intervention to manage profoundly uncomfortable itch, erythematous lesions, and a relapsing course that heavily impacts quality of life.

Targeted Monoclonal Antibodies for Moderate-to-Severe Eczema

Unlike traditional treatments that suppress general inflammation throughout the entire body, biologics are laboratory-engineered monoclonal antibodies designed to target specific molecules and chemical messengers, according to WebMD reporting. Scientists modify genes in bacteria and cells to produce these proteins, which mimic natural human antibodies by seeking out specific antigens involved in eczema symptoms. Four biologic medications have gained FDA approval to treat atopic dermatitis: dupilumab, tralokinumab, lebrikizumab, and nemolizumab.

Dupilumab, marketed as Dupixent, was the first biologic approved for the condition and is authorized for patients aged 6 months and older whose eczema cannot be controlled with topical prescription creams. According to WebMD, dupilumab works by binding to the interleukin-4 receptor alpha, inhibiting both interleukin-4 and interleukin-13 signaling pathways that turn on the body’s inflammation process and weaken skin barrier function. Patients self-administer the medication as a subcutaneous injection every other week or once a month using a prefilled syringe or pen. Common side effects reported in clinical use include injection site reactions, cold sores, and pink eye, or conjunctivitis.

Newer Biologic Options Targeting Specific Interleukins

Following dupilumab, regulators cleared additional targeted therapies that focus more narrowly on specific chemical messengers driving skin damage and pruritus. Tralokinumab, known by the brand name Adbrv, received FDA approval in December 2021 for adults and pediatric patients aged 12 and older with moderate-to-severe eczema, according to WebMD. Tralokinumab targets interleukin-13 exclusively, blocking it from initiating inflammation, and is administered via subcutaneous injection every other week. Reported side effects include upper respiratory tract infections, injection site reactions, and pink eye.

Lebrikizumab, marketed as Ebglyss, gained FDA approval in September 2024 for patients aged 12 years and older with moderate-to-severe atopic dermatitis, targeting interleukin-13 to reduce inflammation, itch, and skin damage with side effects that include eye dryness, redness, and injection site reactions. Nemolizumab, approved in December 2024, is another injectable biologic that blocks interleukin-31, a cytokine that plays a primary role in chronic itch, according to PMC and WebMD summaries.

Experts highlighted that these targeted therapies generally cause fewer side effects than traditional systemic immunosuppressants because they avoid broad systemic suppression, and they can often be used in combination with topical treatments. Even more promising agents remain in development as researchers continue to investigate additional therapeutic targets in late-stage clinical trials.