Biologics For Treating Eczema: A Singapore Dermatologist’s Guide

The Immunology of Eczema

Eczema, specifically Atopic Dermatitis (AD), is more than skin deep, involving complex immunological processes. The immune system, designed to protect the body from infections and diseases, plays a role in AD’s development and persistence.

AD is characterized by an overactive immune response to environmental triggers, which can include allergens, irritants, and even certain foods. This heightened immune activity leads to the production of various cytokines and interleukins, signaling molecules that orchestrate the body’s inflammatory response. Among these, T cells, a type of white blood cell, secrete cytokines such as interleukins IL-4 and IL-13, which are particularly implicated in AD. These molecules encourage inflammation, signal skin cells to reduce barrier function, and even contribute to the itch that is so characteristic of the condition.

Understanding Biologics: Definition and Mechanism

Biologics represent a groundbreaking category of medications that have transformed the treatment landscape for several chronic conditions, including Atopic Dermatitis (AD). Derived from living organisms, biologics encompass a wide range of products, including vaccines, blood components, and cells from humans, animals, or microorganisms. However, in the context of AD, biologics specifically refer to a class of drugs designed to target and modulate the immune system’s components.

Unlike traditional systemic therapies that broadly suppress the immune system, biologics offer a targeted approach. They are engineered to interfere with specific pathways or cells involved in the inflammatory process of AD. This precision not only enhances their efficacy but also minimizes the risk of side effects associated with widespread immunosuppression.

One of the key mechanisms through which biologics operate is by inhibiting the action of cytokines, proteins that play a crucial role in the immune response. For instance, Dupilumab, the first biologic approved for AD treatment, targets the interleukin-4 (IL-4) receptor alpha subunit. This action blocks the signaling pathways of interleukins IL-4 and IL-13, two cytokines significantly involved in the inflammatory response seen in AD. By doing so, Dupilumab effectively reduces inflammation and improves the symptoms of AD without the broad immunosuppressive effects seen with older medications.

The development and approval of biologics like Dupilumab have underscored the importance of understanding the immune system’s role in diseases like AD. It represents a shift towards more personalized medicine, where treatments are tailored to the individual’s specific disease mechanisms. As research progresses, the pipeline of biologics for AD is expanding, offering new hope for patients with moderate to severe forms of the disease who have not responded well to traditional treatments.

Biologics are typically administered via injection or infusion, as their complex molecular structure would be broken down if taken orally. This aspect of biologics underscores the sophistication of these treatments and their ability to offer targeted, effective relief for chronic conditions such as AD.

Dupilumab: A Case Study in Biologic Treatment

Dupilumab, marketed under the name Dupixent, has heralded a new era in the treatment of Atopic Dermatitis (AD), offering significant relief for patients with moderate to severe forms of the disease. As the first biologic drug FDA-approved for AD, Dupilumab’s success has not only provided a much-needed treatment option but also validated the targeted immunological approach to managing this complex condition.

Mechanism of Action

Dupilumab’s mechanism of action is a testament to the precision of biologic therapies. It specifically targets the interleukin-4 (IL-4) receptor alpha subunit, effectively blocking the signaling pathways of IL-4 and IL-13, two key cytokines involved in the inflammatory response of AD. One of the best eczema doctor in Singapore uses this targeted approach helps reduce inflammation and alleviate the symptoms of AD, such as itchiness and skin lesions, without the broad immunosuppressive effects associated with traditional systemic treatments.

Clinical Impact

The clinical trials and real-world use of Dupilumab have demonstrated its efficacy in significantly improving skin appearance, reducing itch, and enhancing overall quality of life for AD patients. Patients treated with Dupilumab have reported fewer flare-ups, less reliance on topical steroids, and a noticeable improvement in sleep quality due to reduced itchiness. These benefits underscore Dupilumab’s role in addressing not just the physical symptoms of AD but also its broader impact on patients’ well-being.

A Catalyst for Further Research

The success of Dupilumab has spurred interest in the development of other biologics targeting different components of the immune response in AD. Recognizing the complex network of cytokines and other immune factors involved in AD has opened multiple avenues for research, focusing on identifying potential targets for new biologic therapies. This expanding pipeline of biologic treatments promises to offer more personalized and effective solutions for managing AD, catering to patients with varying disease profiles and treatment responses.

Safety and Tolerability

Dupilumab’s safety profile has been another area of its success. While no treatment is without side effects, Dupilumab has been generally well-tolerated by most patients, with common side effects being injection site reactions and conjunctivitis. These side effects are typically mild to moderate in severity and manageable in clinical practice. This favorable safety profile, combined with its efficacy, makes Dupilumab a preferred option for many patients and clinicians alike.

Emerging Biologics in Eczema Treatment

The success of Dupilumab in treating Atopic Dermatitis (AD) has paved the way for the development of other biologics, each targeting different aspects of the immune response involved in the disease. This section highlights several promising biologics that are at various stages of clinical development, offering a glimpse into the future of AD treatment.


Tralokinumab is a monoclonal antibody that specifically targets interleukin-13 (IL-13), a key cytokine implicated in the pathogenesis of AD. By inhibiting IL-13, Tralokinumab aims to reduce the inflammatory response that leads to the symptoms of AD. Clinical trials have shown that Tralokinumab significantly improves skin clarity and reduces itchiness, with a safety profile similar to that of Dupilumab. These findings suggest Tralokinumab could be a valuable addition to the treatment options available for AD, especially for patients who may not respond optimally to Dupilumab.


Another promising biologic in the pipeline is Lebrikizumab, which, like Tralokinumab, targets IL-13 but with a different mechanism of action. Lebrikizumab binds to IL-13 with high affinity, preventing it from interacting with its receptors on the surface of various cells involved in the immune response. Early clinical trials have demonstrated that Lebrikizumab can effectively reduce the signs and symptoms of AD, including skin lesions and itchiness. Its development is closely watched by the medical community, as it represents another potential option for patients struggling with AD.


Nemolizumab takes a unique approach by targeting the interleukin-31 receptor (IL-31RA), which is involved in the itch response, a particularly distressing symptom for many AD patients. By blocking the action of IL-31, Nemolizumab can significantly reduce itching, leading to improvements in sleep and quality of life for patients with AD. Clinical studies have highlighted Nemolizumab’s potential as an effective treatment for the itch associated with AD, offering hope for a symptom that has been challenging to manage with existing therapies.

Why Targeted Immune Response in AD Treatment

This approach is grounded in a nuanced understanding of the disease’s immunopathogenesis, where specific cytokines and immune cells play critical roles in mediating inflammation and the subsequent clinical manifestations of AD. The significance of targeting the immune response in AD treatment cannot be overstated, as it offers several key advantages over traditional therapies.

Precision in Treatment

Targeted biologic therapies offer a level of precision that was previously unattainable with conventional treatments. By focusing on specific immune pathways that drive AD, such as the IL-4 and IL-13 pathways targeted by Dupilumab, these therapies can effectively reduce inflammation and improve skin symptoms without broadly suppressing the immune system. This precision minimizes the risk of side effects associated with systemic immunosuppression, such as increased susceptibility to infections.

Improved Patient Outcomes

The targeted nature of biologic therapies has been associated with significant improvements in patient outcomes. Clinical trials and real-world studies have consistently shown that biologics can lead to substantial reductions in AD severity, improvements in quality of life, and decreased reliance on topical corticosteroids. For many patients, these therapies have transformed the management of their condition, offering relief from the relentless itch and discomfort of AD.

Personalized Medicine

The diversity of biologic therapies emerging for AD underscores the move towards personalized medicine in dermatology. Understanding the specific immune pathways active in an individual’s disease allows clinicians to select the most appropriate biologic therapy, optimizing the chances of treatment success. This approach is particularly beneficial for patients who have not responded to traditional treatments, as it offers alternative options tailored to their specific disease mechanisms.

Challenges and Opportunities

Despite the clear benefits, the targeted immune response approach in AD treatment presents several challenges. The cost of biologic therapies, along with the need for ongoing administration, poses accessibility issues for many patients. Furthermore, the long-term safety and efficacy of these treatments remain areas of active research. However, these challenges also represent opportunities for innovation in drug development, patient care strategies, and healthcare policy to ensure that the benefits of these groundbreaking therapies can be realized by all patients in need.