Biologic Medicine for Eczema

My experience with Biologic Medicine for the treatment of eczema.

I’ve been in practice in North Carolina for close to 10 years, and during this time I have been fortunate enough to work with some very good dermatologists. I mean really goooooood dermatologists. I’m the only Allergy/Immunology Physician in our large group, so we’ve developed a very strong working relationship with our shared patients with allergic skin conditions like eczema. So a while back, when the new biologic medication specific for received FDA approval, we were all very interested. I was able to select some patients that were in need of a change.

Many patients tend to have the eczema driven by allergic inflammation, and allergic inflammation was the specific target of this new medication. I am very conservative when it comes to the prescription of brand new meds, especially medications that may affect the body’s ability to fight off infection. The cool thing about this new biologic is that it affects allergic inflammation ONLY, and does not reduce the body’s ability to fight off infections. The dermatologists and I were extremely excited about what this new medication could mean for our patients, and I was able to get some people approved in the first few months.

My first patient was a healthcare worker that had suffered severe skin allergies for over 20 years. While my allergy office has been in the area for 10 years, she had never walked through my doors before, as she had HORRIBLE reactions to allergy shots from other doctors. This poor woman had eczema from her eyelids to her shins, and even talking about her skin whelped up tears because oral steroids had been the only medication that had ever been able to get her skin completely clear – and she HATED steroids. Her allergy testing was through the roof and not surprisingly she reacted severely to even very low dose allergy shots (specific immunotherapy). She was itchy day and night, sleep was impossible from the constant nagging itch.

She was the ideal candidate for a drug that specifically blocked allergic inflammation, and my office got the medication approved within 24 hours. Having never used the drug before, we did not know what to expect. It was like a switch was flipped – within days of her first injection, she stopped itching. By the first week she was sleeping through the night for the first time without oral steroids. Her red flaking skin disappeared over the next few weeks, and by her first follow up appointment her tears of frustration had transformed into tears of joy. She’s one year on therapy – and still doing great!

The second patient I’d like to discuss is another young woman who had developed significant bias and dislike for “modern medicine.” She refused to touch any type of steroid, topical or otherwise, and would not even discuss calcineurin inhibitors with me. Allergy testing was high for dogs and cats, and she could not change her environment enough to avoid the dander driven inflammation. We tried allergy shots, allergy drops, and all sorts of antihistamines. She itched daily. After several exhaustive discussions, she read about the new medication and agreed to give it a try. By her first follow up after starting the new medicine, it was like she had brand new skin. The affected areas on her body that I told her would likely have residual scars were completely clear!

Biologic Therapy hasn’t worked for every patient that we’ve tried, but some of our initial patients had very encouraging successes that I felt compelled to share. The decision to use any type of medication or therapy is an important individual discussion between a patient and their doctor. I hope these stories may trigger some discussions that may not have happened otherwise.

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