Dupilumab (trade name Dupixent), Tralokinumab (trade name Adraltza), and Lebrikizumab (trade name Ebglyss) are medications from the class of biologics that can be used in the treatment of eczema.

Dupilumab, Tralokinumab, and Lebrikizumab are prescribed for the treatment of children and adult patients with moderate to severe eczema who do not respond sufficiently to topical medications or have not tolerated them.

Dupilumab can already be prescribed for children with severe eczema from the age of 6 months.

What are biologics? How do they work in the treatment of eczema?

Biologics are specific antibodies produced biotechnologically. In 2017, the first biologic for the treatment of eczema was approved. Biologics target the inflammatory processes underlying eczema symptoms and help relieve itching and improve skin appearance. They work more specifically than conventional medications and do not suppress the entire immune system.

How do Dupilumab, Tralokinumab, and Lebrikizumab work?

The active ingredient Dupilumab specifically targets interleukins 4 and 13. Tralokinumab and Lebrikizumab are antibodies that target interleukin 13. These interleukins play a crucial role in the development of the inflammatory response responsible for eczema. By inhibiting these interleukins, Dupilumab, Tralokinumab, and Lebrikizumab can reduce the inflammatory response and thereby alleviate symptoms.

What side effects can biologics have?

The most common side effects of Dupilumab and Lebrikizumab include reactions at the injection site. The most common side effect of Tralokinumab was upper respiratory tract infections.

Additionally, rarely, the following accompanying symptoms may occur:

• Conjunctivitis (pink eye)

• Headaches

• Oral herpes

Who is it not suitable for?

Dupilumab, Tralokinumab, and Lebrikizumab should not be used if your child has a hypersensitivity or allergy to the active ingredient. In the event of a hypersensitivity reaction, the therapy must be immediately discontinued.

Dupilumab is approved for children with severe eczema from the age of 6 months. Tralokinumab and Lebrikizumab are approved for children aged 12 and over with moderate to severe eczema.

What are alternatives to biologics?

Alternative treatment options include topical therapies with glucocorticoids or calcineurin inhibitors, phototherapeutic treatments, or JAK inhibitors such as Abrocitinib. Other systemic therapies such as cyclosporine, methotrexate, or azathioprine are still used in exceptional cases in children due to the new biologics or JAK inhibitors. Treatment choices should be discussed individually with a dermatologist or pediatrician.

Don't forget!

Even during treatment with one of the biologics, children's skin requires regular basic care that moisturises and hydrates the skin. This care should definitely be continued.