"Biologics" used as skin treatments are medicines that are bioengineered antibodies extracted from living organisms including plants, fungi, and laboratory animals. Biologic treatments, also referred as biologic therapy, biologicals, and biopharmaceuticals, are used to treat sever cases of autoimmune disease like rheumatoid arthritis as well as long term skin conditions like eczema, and psoriasis.
Biologics work by targeting specific cells involved in the development of these inflammatory skin conditions, aiming to modify the underlying immune system response.
Usually administered by injection or intravenous infusion, biologics work by blocking specific cytokines, which are proteins that play a role in triggering the immune response leading to skin inflammation.
In the past, patients with dermatologic diseases like severe psoriasis and eczema were treated with medications such as prednisone, methotrexate, and cyclosporine. These treatments work by targeting the entire immune system. As a result, they also have many potential negative health impacts. Prednisone can cause weakening of the bones and an increased risk of glaucoma, among a lengthy list of other side effects. Cyclosporine’s side effects include increased blood pressure and a heightened risk of kidney damage. Long-term treatments with methotrexate are linked to liver damage.
Biologics, on the other hand, halt an overactive immune system by more specifically targeting inflammatory pathways rather than the entire immune system.
*It is important to note that biologics are not a cure for long term skin conditions, but they can provide relief from symptoms. Depending on the severity of your skin condition and the response you have had with other treatments, your dermatologist would need to measure if a biologic treatment would be appropriate for you.
Conditions That Can Be Treated with Biologics
Recently developed biologic therapies have revolutionized the treatment of many different diseases. Examples include:
- Rheumatoid arthritis
- Crohn's disease
- Multiple sclerosis
- Diabetic retinopathy
- Gastric, breast and colon cancer
- Forms of leukaemia and lymphoma
- Cystic fibrosis
What are the pros and cons of Biologic Treatments?
Biologics activate certain proteins or cells in your immune system to create specific targeted responses. Biologic molecules are large and may have thousands of atoms, making them more complex.
Whereas conventional systemic drugs, (immunosuppressants or steroids) activate your entire immune system in a more generalised manner. Being a smaller molecule, conventional chemical drugs make a limited number of atoms.
For example, methotrexate and sulfasalazine are two non-biologic drug treatments for rheumatoid arthritis. These drugs affect multiple various parts of a person’s immune system. By contrast, biological treatments for rheumatoid arthritis have specific targets (such as blocking a specific receptor for a targeted immune molecule).
Because biologic drugs are so complex:
- The response is less predictable. They may work better for some people than others, and the response may change over time. This may require changing to another biologic.
- They are more difficult to make, and much more expensive. Some biologics have generic options, but unlike chemical drugs, they are not the same, so they are called biosimilars.
- Because they are usually given by injection or IV, they may cause a reaction at the site of injection or infusion.
- Biologic medicines are made from living organisms, therefore there may be more risk for contamination, so they usually need to be refrigerated.
Side Effects and Risks of Biological Treatments
Potential side effects of biologics vary based on the specific biologic therapy involved. In some cases, these side effects are quite mild, such as a rash. Other common side effects might include respiratory infections, flu-like reactions, or redness at the injection site.
Prior to treatment with a biological medicine, patients must be screened for infections or cancer. During treatment, they should be monitored with routine blood tests for infection markers and have cancer checks, including total body skin examinations.
Your doctor or dermatologist should know the possible adverse events associated with a biological treatment before it is prescribed.
- Patients should be monitored for allergic reactions.
- Immune reactions may result in loss of efficacy of the biological treatment.
- Severe reactions such as anaphylaxis are possible and require the biological treatment to be discontinued.
- Many of these treatments come with a risk of immunosuppression. Meaning that part of your immune system cannot respond to fight off infections the way it normally would.
Biologic Treatments for Eczema
Biologics for eczema target specific proteins in the body, which can help reduce overactivity in the immune system and calm eczema symptoms. Unlike traditional drugs, which are made from chemical compounds, biologics for eczema are made from living organisms. These injectable medications affect a specific immune response to help reduce the inflammation that causes eczema symptoms.
There are currently two FDA approved biologics to help treat eczema with more than twenty-five in development.
Dupixent is prescribed to adults and children 6 months and older to treat severe eczema (atopic dermatitis). It is prescribed to eczema sufferers who have not responded well to other topical medications. Dupixent contains the active ingredient dupilumab and comes in prefilled syringes as a single dose.
Common side effects of Dupixent may include:
- pain, swelling, or irritation at injection site.
- blood vessel inflammation
- eye redness, itching or puffy eyelids.
- stomach pain, nausea, vomiting or diarrhea.
- cold symptoms such as stuffy nose, sneezing, sore throat
- skin sores or blisters
- joint or muscle pain
- cold sores or fever blisters on your lips or in your mouth
Most systemic therapies work by suppressing the immune system. While that can help reduce eczema symptoms, it can make it harder for your body to fight other illnesses and infections. Biologics for eczema are different in that they target a specific component of the immune system, rather than the entire system. They also do not contain steroids.
However, biologics can cause side effects as listed above, so it is important to weigh the risks and benefits of any medication with a healthcare professional.
While eczema can be a lifelong disease, many at-home measures and medications are available to manage symptoms and reduce flares. Biologics are among the newest treatment options on the market. As new biologics for eczema become available, people will have even more options to choose from. However, biologics for treating eczema can weaken the immune system, so it is important to discuss that and other risks with your healthcare professional.
Biologic Treatments for Psoriasis
Biologic medications can treat psoriasis and other autoimmune conditions by slowing down or blocking parts of the immune system. They do this by targeting the certain antibodies and components of the inflammatory process. Unlike general immunosuppressants that suppress the entire immune system, biological agents can fight more selectively and target only those chemicals involved in causing psoriasis. While biologics for psoriasis can be effective, reactions can result in altering your response to infection and your susceptibility to malignancies.
There are currently eleven biologics for psoriasis:
- Secukinumab (Cosentyx)
- Etanercept (Enbrel)
- Adalimumab (Humira)
- Infliximab (Remicade)
- Brodalumab (Siliq)
- Ustekinumab (Stelara)
- Ixekizumab (Taltz)
- Guselkumab (Tremfya)
- Certolizumab (Cimzia)
- Tildrakizumab (Ilumya)
- Risankizumab (Skyrizi)
Biologics used in the treatment of psoriasis can cause a slightly increased risk of infection in the skin, either from bacteria, fungus, or virus.
The most common adverse drug reactions associated with biologic injections include pain, swelling, itching, rash, and redness at the injection site. Because of their precise targets, biological agents appear not to damage the entire immune system the way that general immunosuppressants do. However, biological agents should still be considered immunosuppressive and may increase the risk of infection and reactivation of tuberculosis (TB).
Uncommon infections with organisms such as listeria and legionella may be more common and more serious in patients on biological agents.
Biologics have proven to be an effective treatment option for people with chronic skin conditions. A dermatologist can help determine the risks and benefits of biologics for an individual patient and whether they are a suitable treatment option.
While there are potential risks and side effects associated with biologics, patients have experienced significant improvement in their skin conditions and an overall improvement in their quality of life. If you are struggling with a chronic skin condition and are interested in exploring biologics as a treatment option, it is important to consult with a dermatologist.