Your immune system helps make cells to attack harmful things that get into your body, like germs, and send signals for the immune cells to get to work. These activities are part of the inflammatory response. Once your immune system kills the germs, the usual response is for it to stop the attack and go back to normal. In some cases, the inflammatory response doesn’t stop. It starts to attack healthy parts of your body.
In the case of atopic dermatitis (AD), certain cells of your immune system (some known and some unknown) become overactive. Two important ones are interleukin-4 (IL-4) and interleukin-13 (IL-13). IL-4 and IL-13 help turn off the immune system’s inflammatory response when it’s time. If these cells are overactive, skin changes happen. This can lead to AD flare-ups. Other cells in the immune system send signals for the immune cells to attack. Some of these signals are called Janus kinases (JAK).
The best way to treat AD is to fix the parts of the immune system that aren’t working right and help slow down the inflammatory response. Some medications for AD target IL-4 or IL-13. There are called biologics. Some medications stop the inappropriate signals. These are called JAK inhibitors. Both types of medications target specific parts of the immune system. That lets the rest of the immune system do its job and protect you from harmful things.
Biologics can be a good option for those with AD who don’t respond well to or have harmful side effects from other treatments, like creams and steroids.
The first biologic approved by the U.S. Food and Drug Administration (FDA) for AD was dupilumab (Dupixent) made by Sanofi. It specifically targets IL-4. Dupilumab is given by a shot under the skin every other week. The best spots for these shots are usually the thigh, stomach area or upper arm. Dupixent comes in a syringe that is already filled or an injection pen.
Tralokinumab-ldrm (Adbry) made by Leo is another biologic. It targets IL-13. Tralokinumab-ldrm also comes in a prefilled syringe and is given by a shot under the skin. Your prescriber/physician/clinician may decide that you need more than one syringe each time to get your full dose. You usually start with tralokinumab-ldrm every two weeks, then gradually go to every four weeks.
It is often possible for you or your caregiver to give the injections. Talk to your doctor to see if this might be right for you. You or your caregiver will be trained on how to prepare and inject the medication.
Two other new medications are abrocitinib (Cibinqo) made by Pfizer and upadacitinib (Rinvoq) made by Abbvie. These medications work differently than dupilumab and tralokinumab-ldrm. They are called JAK inhibitors and block some of the signals that cause inflammation. Abrocitinib and upadacitinib are pills that you take by mouth. They are often prescribed when other medications don’t work well enough for you or you can’t tolerate them.