A recent biological treatment, dupilumab, is offering relief to patients with severe atopic eczema whose skin conditions don’t respond to traditional topical treatments, according to Swedish dermatologists.
Mikael Alsterholm, a senior physician in dermatology and venereology at Sahlgrenska University Hospital, explained that dupilumab is intended for individuals with severe eczema that hasn’t improved with the use of emollients combined with strong corticosteroid creams and calcineurin inhibitor creams. The treatment, administered via injection every two to four weeks depending on age, can be used in patients as young as six months vintage.
While often providing significant relief from itching and skin lesions, dupilumab isn’t without potential side effects. Alsterholm noted that eye irritation, including itchiness and excessive tearing, is a common concern. However, he added that this can often be managed with daily use of moisturizing gel and eye drops, though the extent of this necessitate varies considerably between patients.
Dupilumab has generally demonstrated a favorable safety profile, with relatively few serious side effects reported. However, in rare cases, eye irritation can be severe enough to necessitate discontinuation of the treatment.
The availability of dupilumab is currently limited to those with the most severe forms of eczema. Alsterholm emphasized that many patients, both children and adults, experience mild to moderate eczema that responds well to conventional topical treatments. This means that the biological treatment is reserved for those who have exhausted other options.
The long-term nature of dupilumab treatment remains an open question. Alsterholm acknowledged that the severity of atopic eczema fluctuates significantly throughout a person’s life, suggesting that the need for treatment may likewise vary over time.
The use of corticosteroid creams, while effective in quickly reducing inflammation and itching, also carries potential risks, particularly with prolonged use. Thinning of the skin, increased visibility of blood vessels, and the development of stretch marks are among the possible side effects. Long-term use can compromise the skin’s protective barrier, making it more susceptible to infection. A specific rash around the mouth and nose, known as perioral dermatitis, can also occur, ironically sometimes worsened by attempts to treat it with more corticosteroids.
Experts caution against abruptly stopping corticosteroid treatment, as this can lead to a rebound effect and a flare-up of eczema symptoms. A gradual tapering-off approach, guided by a healthcare professional, is crucial to minimize the risk of relapse.
