









































Pa
ge

 
1



Pa
ge

 
61

American Journal of  
Life Science and Innovation (AJLSI)

Revolutionizing Pediatric Dermatology: Dupilumab’s Impact on Atopic Dermatitis in 
Kids

Eiman Hamza Ahmed Elsayed1*, Rabab Elsayed Ali Hassan Khater2 

Volume 3 Issue 1, Year 2024
ISSN: 2833-1397 (Online)

DOI: https://doi.org/10.54536/ajlsi.v3i1.2696
https://journals.e-palli.com/home/index.php/ajlsi

Article Information ABSTRACT

Received: May 01, 2024

Accepted: May 31, 2024

Published: June 04, 2024

Eczema, or atopic dermatitis, is a common, non-communicable, immune-mediated, 
inflammatory skin illness mainly affecting children. It is a chronic condition. It causes 
mental health problems like anxiety, sadness, anxiety, depression, hyperactivity, and obesity. 
It is the first skin ailment and the fifteenth non-fatal disease. The purpose of  the present 
research study was to evaluate the Safety and Effectiveness of  biological treatment for 
atopic dermatitis using monoclonal antibodies against non-biological treatment, including 
antibiotics, immunosuppressants, demards, histamine antagonists and corticosteroids. 
Patient information was gathered from FDA-approved clinical trials. The comparative 
analysis found that Biological therapies like Dupilumab, Omalizumab, and Ustekinumab 
improve symptoms and disease control in atopic dermatitis. Non-biological treatments 
may not be as effective. Early antibiotic exposure can increase infection vulnerability. Mild 
eczema infections require biological agents. Topical corticosteroids can be combined with 
Dupilumab for effective treatment of  atopic dermatitis. Studies show that Dupilumab 
improves symptoms and quality of  life, making it a better option than a placebo. FDA 
recommends using biological agents over immunosuppressants in paediatrics for improved 
immune results. FDA clinical trials showed that dupilumab is a safe and effective treatment 
for children with moderate-to-severe atopic dermatitis, reducing disease severity and 
improving quality of  life in young AD patients.

Keywords

Atopic Dermatitis, 
Pediatrics, Dupilumab, 
Immunosuppressants, Monoclonal 
antibodies Corticosteroids

INTRODUCTION
Atopic dermatitis (AD), known as Eczema, is a common, 
chronic, non-communicable, immune-mediated 
inflammatory skin condition that mostly affects children. 
It ranks first among all skin illnesses and 15th among non-
fatal diseases (Rusiñol & Puig, 2024). It typically manifests 
within the first six months of  life. It harms general health 
and is linked to a higher occurrence of  mental health 
conditions and symptoms, including anxiety, depression, 
hyperactivity, sleep problems, asthma, hay fever, 
cardiovascular disease, stroke, and obesity (Chovatiya & 
Silverberg, 2019; Nicholas et al., 2022; Xu et al., 2019).
It is caused by changes in the skin microbiotaimmune 
system hyperactivity, sensitivity to immunoglobulin 
E, neuro-inflammation (Mandlik & Mandlik, 2021), 
environmental variables, and hereditary predisposition. 
(Grobe et al., 2019; Mehta & Fulmali, 2022). The intricate 
interactions between itch, inflammation, and barrier failure 
play a crucial role in this condition’s onset, progression, 
and chronicity, even though the pathophysiological 
mechanisms are yet unknown. 
Skin inflammation that is aggravated by filaggrin 
abnormalities, intercellular lipids, and tight junctions 
is the hallmark of  type 2 immune deviation. These 
abnormalities lead to barrier disruption in the skin, 
producing thymic stromal lymphopoietin, interleukin 
(IL)-25, and IL-33. 
Subsequently, this inflammation intensifies the 
breakdown of  the epidermal barrier by suppressing 

filaggrin expression in keratinocytes. Moreover, various 
pruritogens and itch mediators generated during this 
inflammatory process can directly affect sensory nerves 
and induce itching (Kim et al., 2019; Nakahara et al., 
2021). While in some children, food allergies are closely 
associated with AD, 30% of  these children experience 
symptoms such as rash, itching, leaking, and dry, cracked 
skin. Smaller kids show intolerance to some foods.
Red, weepy, crusty, itchy, and flaky skin patches that 
typically form in oval or circular forms are its defining 
feature (Rusiñol & Puig, 2024). Age-related symptom 
variations include red rash in infants, thickened rash in 
children, and scaly rash in teens and adults. Common 

1 Pediatric Specialist in UAE
2 Dermatology Specialist in UAE
* Corresponding author’s e-mail: dr_eh2412@yahoo.com

Figure 1: Conditions related to atopic dermatitis



Pa
ge

 
62

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

features include extra skin folds and darkening (Frazier & 
Bhardwaj, 2020; Soares et al., 2024).
For patients with moderate to severe types of  atopic 
dermatitis (AD), biological therapies are very important. 
These therapies concentrate on particular molecules 
involved in the inflammatory and immunological 
responses typical of  AD. Compared to more conventional 
treatments like corticosteroids or immunosuppressive 
medications, biological therapies like monoclonal 
antibodies like Dupilumab and Tralokinumab provide a 
more tailored approach by concentrating on particular 
molecular targets (Deleanu & Nedelea, 2019).
New insights into the immunopathology of  AD have 
made it possible to identify therapeutic molecular targets 
for innovative biological therapies. By modifying the 
immune response and inflammatory pathways, these 
treatments; including “IL-4/IL-13” inhibitors, JAK 
inhibitors, and “IL-13 inhibitors” have demonstrated 
notable success in treating AD. Furthermore, the FDA 
has approved biologics like Dupilumab for treating 
moderate-to-severe AD, demonstrating their efficacy in 
enhancing patients’ quality of  life and symptom relief  
(Zhou et al., 2021). 
It provides a more focused and targeted approach. 
Research has indicated that biological treatments are a 
useful means of  alleviating symptoms. Furthermore, 
biologics have demonstrated a quick start of  action, 
offering immediate relief  to patients who have not 
responded well to traditional therapy. Clinical trials and 
real-world applications have provided strong evidence 
for the Safety and Effectiveness of  biological therapy 
(Caffarelli et al., 2023; Montes-Torres et al., 2015).
The present research paper aimed to evaluate and 
compare the efficacy, optimal dosage, and frequency 
of  administration of  biological treatment such as 
monoclonal antibody Dupilumab with standard 
treatment options, including antibiotics, corticosteroids, 
Immunosuppressants such as cyclosporine, 
mycophenolate, tacrolimus, and azathioprine, histamines, 
and Demards like Methotrexate in the management of  
atopic dermatitis in pediatric patients.

Methods and Clinical Trials
The research study on “Revolutionizing Pediatric 
Dermatology: Dupilumab’s Impact on Atopic Dermatitis 
in Kids” was conducted by employing the approved 
clinical trials studies of  “United States-Food & Drug 
Administration (FDA)” among individuals of  different 
ages, ethnicity, genders and health status.

Biological Treatment Options
Efficiency of  Biological Treatment 
Systemic non-biological therapies, such as oral 
corticosteroids, cyclosporine, Methotrexate, azathioprine, 
and mycophenolic acid, effectively manage moderate 
to severe atopic dermatitis (Paolino et al., 2023). Non-
biological systemic therapy for atopic dermatitis may not 
be as effective at controlling symptoms and preventing 

exacerbations as biological treatments are (Ferrucci et al., 
2023). 
Meanwhile, biological therapies, including Dupilumab, 
Omalizumab, and Ustekinumab, offer a more targeted 
approach focusing on molecules linked to the immune 
response and inflammatory processes in AD. These 
biologics have shown a significant improvement in 
symptoms and quality of  life for those with moderate 
to severe AD (Chu et al., 2023) and disease control by 
targeting key pathways involved in AD pathogenesis, 
such as Th2, Th22, Th17/IL-23, and IgE. 

Monoclonal Antibody Dupilumab
Dupilumab obstructs the signalling pathways for 
interleukin 13 (IL-13) and 4 (IL-4). Attaching to the 
alpha subunit of  the interleukin-4 receptor (IL-4Rα), 
this method of  action functions as a receptor antagonist. 
Dupilumab specifically targets two important cytokines 
involved in asthma and atopic dermatitis inflammation: 
“IL-4 and IL-13” intracellular signalling. The simultaneous 
inhibition of  “IL-4 and IL-13” signaling enhances skin 
barrier function, reduces type 2 inflammation, reduces 
itching, and improves skin lesions in people with atopic 
dermatitis. (Kraft & Worm, 2017).
Dupilumab significantly enhances clinical scores and 
symptoms in children with severe atopic dermatitis aged 
6-11 years, improving their quality of  life and smoother 
skin (Berna-Rico et al., 2023; Cork et al., 2024).
The recommended dosages and frequency of  dupilumab 
for children with atopic dermatitis are weight-based and 
range from 200 mg to 300 mg for children weighing 15 to 
30 kg, 30 to 40 kg, and 40 kg or more (Berna-Rico et al., 
2023; Cork et al., 2024; Kamal et al., 2021).

Comparison with Other Treatment Modalities
Antibiotics for Atopic Dermatitis
Since secondary skin infections frequently arise in AD 
patients, antibiotics, including cephalexin, clindamycin, 
doxycycline, azithromycin and amoxicillin/clavulanic 
acid, are frequently used to manage AD. 
In eczematous lesions of  atopic patients, Staphylococcus 
aureus colonization is common. It releases superantigens 
and exotoxins that prolong inflammatory reactions and 
worsen symptoms. Patients with AD are often offered 
topical antibiotics such as gentamicin, fusidic acid, and 
mupirocin for mild to moderate secondary infections 
(Neri, 2015).

Cephalexin
Is a first-generation cephalosporin used to treat 
Staphylococcus aureus-related skin infections in 
atopic dermatitis, particularly in those with colonized 
Staphylococcus aureus. Its bactericidal activity supports 
its use in treating atopic dermatitis, prophylaxis, and 
minor procedures (Class et al., 2022; Rist et al., 2002).

Clindamycin
A Lincosamide antibiotic, is used to treat severe skin and 



Pa
ge

 
63

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

soft tissue infections caused by Staphylococcus aureus. 
It works well against aerobic and anaerobic bacteria, 
especially in those with S. aureus colonization due to 
atopic dermatitis (Coskey, 1978; Mose et al., 2022).

Doxycycline
A tetracycline antibiotic doxycycline, has been investigated 
for treating atopic dermatitis (AD). Doxycycline may 
be able to treat AD since research indicates that it may 
include anti-inflammatory qualities and antibacterial 
benefits. Doxycycline may have a role in regulating the 
immune response in allergy disorders such as AD. 
Its use has been widely demonstrated to reduce mast 
cell histamine release and asthmatic patients’ levels 
of  immunoglobulin E (IgE) for skin disorders such as 
rosacea, acne, and perioral dermatitis (Bohannon et al., 
2020; Hulme, 2023); It also functions by destabilizing nitric 
oxide synthase (NOS), which can reduce inflammation 
and improve symptoms of  atopic dermatitis by increasing 
degradation. It is frequently used to treat skin conditions 
such perioral dermatitis, acne, and rosacea. (Bohannon et 
al., 2020). 

Effectiveness and Limitations
Children who were exposed to antibiotics in their early 
years had a higher chance of  acquiring adverse events. 
Irrational and direct use of  broad-spectrum antibiotics 
increases susceptibility to infections and resistance rates, 
potentially leading to fatal diseases.
The relative efficacy of  antibiotics and biological 
treatment for pediatric atopic dermatitis depends on 
the particular circumstances and degree of  the ailment. 
Although they have a limited effect in treating the 
underlying inflammation of  Atopic dermatitis, antibiotics 
are frequently used to treat infections that may worsen 
the symptoms of  atopic dermatitis. According to 
research, antibiotics may not significantly help children 
with minor eczema infections, and they may even increase 
skin sensitivity and resistance(Choi et al., 2020; Li et al., 
2021; Mubanga et al., 2021).

Corticosteroids in Atopic Dermatitis Management
Depending on the severity of  the ailment, different 
dosages and potencies of  corticosteroids, such as 
Hydrocortisone, fluticasone, betamethasone valerate, and 
tacrolimus, are frequently given to treat atopic dermatitis 
(Drucker et al., 2018; Stacey & McEleney, 2021).

Hydrocortisone
Hydrocortisone is frequently used for the treatment of  
atopic dermatitis in a variety of  dosages and formulations. 
Hydrocortisone comes in various formulations for atopic 
dermatitis, with concentrations ranging from 0.1% to 
2.5%. These formulations include creams, lotions, gels, 
solutions, and ointments. 
Lower potency hydrocortisone formulations “(class VI or 
VII), such as 1% cream” or ointment, are usually used 
for infants and children with atopic dermatitis. These 

formulations are administered twice a day to reduce 
inflammation and itch. 
Low-potency steroids should be used for maintenance 
in cases of  mild atopic dermatitis after intermediate-
potency steroids (class III, IV, and V) are taken for 
short periods to control flare-ups in severe atopic 
dermatitis cases in teenagers (Haeck et al., 2011), while 
their excessive strength may result in negative side effects 
such as folliculitis, dermatitis, acne, atrophy of  the skin, 
itchiness, changes in pigmentation, and inhibition of  the 
hypothalamic-pituitary-adrenal axis (Axon et al., 2021).

Fluticasone
A corticosteroid, is available in several formulations and 
doses ranging from 0.05% to 2.5%. It is used in atopic 
dermatitis to reduce inflammation and symptoms by 
suppressing the release of  inflammatory mediators 
(Dhamija et al., 2024). 
On the other hand, a variety of  negative side effects 
might occur, such as increased hair growth, dizziness, 
rash, itching, and redness of  the treated area of  skin. 
Hives, breathing difficulties, swelling of  the lips, tongue, 
or throat, skin pain, tenderness, or swelling, wounds that 
do not heal, severe skin irritation, or signs of  systemic 
absorption such as weight gain, thinning or discolored 
skin, increased body hair, nausea, diarrhoea, fatigue, 
mood swings, menstrual changes, and sexual changes, as 
well as severe headaches, confusion, muscle weakness, 
vision abnormalities, heart symptoms, or serious allergic 
reactions are examples of  serious side effects that can 
occur. (Berth-Jones et al., 2003; Harvey et al., 2023).

Betamethasone Valerate
0.1% twice daily for three to five days. The corticosteroid 
betamethasone can efficiently manage Children’s eczema 
flare-ups, which enhances skin barrier function and 
reduces skin inflammatory responses (Subramanian et al., 
2018).

Topical & Oral Corticosteroids Effectiveness in 
Comparison with Dupilumab-FDA
It has been shown that Dupilumab (Dupixent) can be used 
with or without topical corticosteroids in the treatment of  
disorders like atopic dermatitis based on the information 
from the sources that have been presented, including the 
FDA clinical trials and reviews on the drug. Dupilumab 
is a useful therapeutic option for moderate-to-severe 
atopic dermatitis since clinical trials have demonstrated 
that adding it to topical corticosteroids has significantly 
improved patient-reported symptoms and quality of  life. 
According to a study, dupilumab is far more effective 
than a placebo in relieving the condition of  individuals 
with atopic dermatitis when used in conjunction with 
topical corticosteroids.
These trial studies have demonstrated the advantages 
of  using Dupilumab with topical corticosteroids, 
highlighting the drug’s efficacy in treating atopic 
dermatitis and minimizing the need for corticosteroids 



Pa
ge

 
64

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

alone. Consequently, dupilumab combined with topical 
corticosteroids is a beneficial therapeutic strategy for 
diseases like atopic dermatitis, providing patients with 
better results and a higher quality of  life, according to 
data from FDA clinical trials and reviews (FDA, 2017).

Immunosuppressant’s 
Cyclosporine
A calcineurin inhibitor, targets T cells specifically, inhibiting 
the transcription of  the interleukin 2 gene, modifying the 
immune response, and lowering inflammation in diseases 
such as atopic dermatitis, typically administered at a 
dose of  “5 mg/kg/day” and available in multiple forms, 
including intravenous formulations, oral solutions, and 
gelatin capsules (Amber & Tabassum, 2020; Antti et al., 
2021; Megna et al., 2017; Rajagopalan et al., 2022).

Mycophenolate
Based on numerous investigations and clinical trials, 
Mycophenolate mofetil (MMF) has demonstrated 
promising outcomes in treating atopic dermatitis. Studies 
showed that MMF is useful in treating moderate to 
severe AD among individuals who did not respond to 
conventional treatments; there was a notable improvement 
in the severity of  the illness. MMF significantly reduced 
the SCORAD index, a gauge of  the severity of  AD, within 
a few weeks of  treatment; it may be a useful substitute for 
people with severe or refractory types of  AD because of  
fewer risks of  causing adverse effects than other long-
term therapies for the disease (Phan & Smith, 2020). 

Azathioprine
Immunosuppressive drugs like azathioprine prevent the 
manufacture of  purines, which impacts lymphocytes and 
helps regulate the immune system in atopic dermatitis 
(AD) by lowering inflammation and managing symptoms. 
The recommended daily dose of  azathioprine for AD is 
1-2.5 mg/kg, with adjustments based on individual patient 
response and tolerance. It can cause myelosuppression, 
increased risk of  infection, and gastrointestinal problems. 

Safety profile & Clinical trials of  Immunosuppressants 
in Comparison with Dupilumab
According to the information provided by the sources, 
including the FDA approvals and clinical trials on the 
drug, Dupilumab, also known as Dupixent, has been the 
subject of  substantial research spanning over “60 clinical 
trials” involving over “10,000” patients with various 
chronic conditions. 
For the treatment of  disorders such as asthma, atopic 
dermatitis, chronic rhinosinusitis with nasal polyposis, and 
eosinophilic esophagitis, Dupilumab, a completely human 
monoclonal antibody that inhibits interleukin-4 (IL-4) 
and interleukin-13 (IL-13) signaling has demonstrated 
noteworthy clinical advantages. Dupilumab’s Effectiveness 
in lowering type 2 inflammation, a major factor in many 
illnesses, has been demonstrated by these trials.
Specifically, the FDA has approved Dupilumab for kids 

with eosinophilic esophagitis aged one year and older, 
as well as kids with moderate-to-severe atopic dermatitis 
aged six months to five years. (FDA, 2019).

Demards (Disease-Modifying Anti-Rheumatic Drugs)
Methotrexate 
Inhibits the immune system by inhibiting DNA synthesis 
and cell division by blocking dihydrofolate reductase. For 
AD, Methotrexate is administered at a starting dose of  
10.3-2.6 mg/week, which can be changed according to 
the patient’s tolerance and reaction. Weekly increases are 
possible, with maintenance dosages of  about “11.7 mg” 
(Lee et al., 2020; Shah et al., 2018).

Comparison with Biological Agents Like Dupilumab 
on Based on Clinical Trials
In individuals with moderate to severe atopic dermatitis, 
Dupilumab has been demonstrated to be more successful 
than Methotrexate in reducing symptoms and quality of  
life. This conclusion is based on FDA clinical trials and 
real-world analysis comparing the two medications. 
When compared to Methotrexate, the trials showed 
that Dupilumab improved atopic dermatitis symptoms 
and signs more, and there were fewer side effects and 
treatment discontinuations. For treating atopic dermatitis, 
Dupilumab is therefore thought to be more effective and 
tolerable than Methotrexate, according to data from FDA 
clinical studies and real-world research (FDA, 2017).

Histamines in Atopic Dermatitis Treatment
Histamine antagonists, which block H1 and H4 
receptors, reduce inflammation, nervous irritability, 
and itching to treat the symptoms of  atopic dermatitis 
(AD). Chronic dermatitis lesions lessen pruritus and 
inflammatory cytokines; in AD mice models, they have 
anti-inflammatory and anti-pruritic properties (Albrecht 
& Dittrich, 2015; Ohsawa & Hirasawa, 2014; Schaper‐
Gerhardt et al., 2020).

Histamine Antagonist’s Comparison with Dupilumab-
FDA Clinical Trials
According to FDA clinical trials, Dupilumab is superior 
to histamine antagonists in treating disorders like atopic 
dermatitis and chronic spontaneous urticaria. Atopic 
dermatitis patients with moderate-to-severe AD have 
shown notable improvements in their quality of  life and 
a reduction in the severity of  their condition after using 
Dupilumab, an interleukin-4 receptor alpha antagonist. 
Dupilumab, on the other hand, may provide a more 
thorough treatment of  the disease’s underlying 
inflammatory processes than histamine antagonists, 
which target histamine receptors to relieve symptoms 
like pruritus. Dupilumab is a better therapy choice than 
histamine antagonists for disorders including atopic 
dermatitis and chronic spontaneous urticaria because of  
its demonstrated ability to relieve signs and symptoms 
of  AD with a tolerable safety profile (Hon et al., 2021; 
Clinical trials 2017).



Pa
ge

 
65

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

Tacrolimus as an Immunosuppressant
Atopic dermatitis (AD) has found a valuable new therapy 
option in tacrolimus, a macrolide calcineurin inhibitor. It 
achieves its therapeutic effects through immune response 
modulation and inhibition of  inflammatory processes 
linked to AD progression. In the treatment of  moderate 
to severe AD, topical tacrolimus has demonstrated 
efficacy and safety, providing a non-corticosteroid option. 
Research has shown that tacrolimus ointment (available 
in 0.03% and 0.1% concentrations) is more effective 
in treating AD than pimecrolimus and moderate 
corticosteroids. Tacrolimus works by attaching itself  to 
particular T cell receptors, which raises intracellular calcium 
levels and inhibits the transcription of  cytokines such as 
“IL-2, IL-4, and IL-5”. Clinical studies have demonstrated 
topical tacrolimus’s Effectiveness in lowering AD severity 
ratings and improving safety profiles with less systemic 
absorption (Martins et al., 2015; Umar et al., 2022). 

Safety Profile & Clinical Trials in Comparison with 
Dupilumab 
Compared to tacrolimus, the FDA clinical trials have 
yielded strong evidence for the safety and Effectiveness of  
dupilumab in treating ailments such as atopic dermatitis. 
Atopic dermatitis patients with moderate-to-severe AD 
have shown notable improvements in their quality of  
life and a reduction in the severity of  their condition 
after using Dupilumab, an interleukin-4 receptor alpha 
antagonist. 
Dupilumab is a better therapy option than tacrolimus 
for AD patients due to its great efficacy in reducing 
symptoms and enhancing quality of  life, as demonstrated 
by clinical trials. Dupilumab is a better therapy choice 
than tacrolimus because of  its focused mechanism of  
action and excellent safety profile (FDA, 2019).

Summary of  FDA-approved Clinical Studies 
According to FDA clinical trials, Dupilumab has proven 
to be a highly effective and safe treatment for moderate-
to-severe atopic dermatitis in children. In children with 
atopic dermatitis, aged “6 to 11 years”, who are not 
sufficiently managed by traditional therapy such as topical 
corticosteroids and emollients, these trials have assessed 
the real-world Effectiveness of  dupilumab. Research has 
indicated that Dupilumab significantly improves overall 
quality of  life, pruritus, sleep quality, and disease severity 
in young AD patients.
More specifically, at week sixteen of  treatment, a large 
percentage of  patients showed statistically significant 
improvements in the “Children’s Dermatology Life 
Quality Index (c-DLQI), Sleep NRS (S-NRS), Pruritus 
Numerical Rating Scale (P-NRS), and Eczema Area 
Severity Index (EASI) scores”. Based on these results, 
young patients with moderate-to-severe atopic dermatitis 
can benefit from using dupilumab as a treatment 
option. It is a viable therapeutic alternative beyond 
topical medications (FDA, 2019; Kamphuis et al., 2022; 
Napolitano et al., 2022).

DISCUSSION 
Eczema, or atopic dermatitis, is a chronic, non-
communicable, inflammatory skin ailment mainly 
affecting children. It ranks first among skin conditions 
and fifteenth among non-fatal diseases, and it can cause 
mental health problems.
Biological therapies like Dupilumab, Omalizumab, and 
Ustekinumab target immune response and inflammatory 
processes in atopic dermatitis, improving symptoms, 
quality of  life, and disease control. In contrast, Non-
biological systemic therapy for atopic dermatitis may not 
be as effective in controlling symptoms and preventing 
exacerbations as biological treatments.
Early exposure to antibiotics can raise a child’s vulnerability 
to infections and resistance rates, which can result in 
life-threatening illnesses. The severity of  the condition 
determines how well biological therapy and antibiotics 
work for pediatric atopic dermatitis. Dupilumab and 
other biological agents are suggested for children with 
mild eczema infections.
Topical corticosteroids can be used alone or with 
dupilumab, a medication used to treat atopic dermatitis. 
Clinical investigations demonstrate that augmenting 
corticosteroids with dupilumab greatly improves 
patients’ symptoms and quality of  life. According to 
studies, dupilumab is a better treatment option for atopic 
dermatitis than a placebo, especially when used with 
topical corticosteroids.
According to FDA guidelines, biological agents are 
preferred in paediatrics over Immunosuppressant 
including cyclosporine, mycophenolate, azathioprine 
and antimetabolite methotrexate because of  their 
Effectiveness in enhancing immune results rather than 
inhibiting the body’s immune system.
It was evident from FDA clinical trials that dupilumab is 
a safe and effective treatment for children with moderate-
to-severe atopic dermatitis, ages 6 to 11. Studies reveal 
that in young AD patients, it considerably reduces the 
severity of  the disease, pruritus, and general quality of  life. 
In addition to conventional topical drugs, this treatment 
provides a good therapeutic alternative.

Challenges and Considerations
Cost-effectiveness of  Dupilumab in Comparison 
with Non-biological Treatments 
The analysis revealed that although the costs of  
Dupilumab may be higher than those of  non-biological 
treatments like topical medicines, it is related to more 
“Quality-Adjusted Life Years (QALYs)” and good 
cost-effectiveness ratios. It suggests that compared to 
more affordable standard treatments like moisturizers 
and emollients, Dupilumab adds value by significantly 
increasing health outcomes.
According to the research, dupilumab presents a novel 
and efficacious therapeutic option for patients with 
moderate-to-severe atopic dermatitis, particularly 
when the Effectiveness of  conventional treatments is 
compromised. The severity of  the ailment affects how 



Pa
ge

 
66

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

cost-effective Dupilumab is compared to non-biological 
treatments; more severe patients are likely to benefit more 
from Dupilumab in terms of  better health and quality 
of  life (Anderson III & Szefler, 2019; Sonya Kahn et al., 
2018).

Adherence to Treatment Regimens in Pediatric 
Patients
In comparison to non-biological therapy, pediatric 
children with atopic dermatitis seem to adhere better to 
Dupilumab treatment regimens. Research has indicated 
that children with moderate-to-severe atopic dermatitis 
can experience improvements in disease severity, pruritus, 
sleep quality, and overall quality of  life while using the 
completely human monoclonal antibody Dupilumab. 
Based on actual data from clinical trials, Dupilumab 
significantly improves pediatric patients’ scores on the 
“Eczema Area Severity Index (EASI), Pruritus Numerical 
Rating Scale (P-NRS), Sleep NRS (S-NRS), and Children’s 
Dermatology Life Quality Index (c-DLQI)”. Dupilumab 
is well-tolerated and efficacious in juvenile populations, 
as evidenced by the high percentage of  patients achieving 
“EASI75” and the significant mean percentage reduction 
in P-NRS, S-NRS, and c-DLQI scores (Napolitano et al., 
2022; Papp et al., 2021).

CONCLUSION
Potential Advancements in Biological Therapies for 
Atopic Dermatitis
Targeted biological therapy dupilumab addresses 
treatment resistance and lowers the likelihood of  relapse 
in patients with atopic dermatitis, improving treatment 
results and quality of  life. This development in biological 
treatments is immensely beneficial in treating chronic 
inflammatory diseases like atopic dermatitis.

Importance of  Personalized Treatment Approaches
Optimizing results for children with disorders such as 
atopic dermatitis requires the use of  personalized therapy 
techniques utilizing monoclonal antibodies, such as 
Dupilumab.
Personalized treatment is a helpful therapeutic option 
for inadequately controlled atopic dermatitis, as studies 
in children aged 6-11 reveal significant improvements in 
disease severity, pruritus, sleep quality, and quality of  life.

RECOMMENDATIONS
➢ Real-world data on Dupilumab’s Effectiveness in 

diverse pediatric populations is needed to validate clinical 
trials and provide insights into its wider patient cohorts.

➢ Examine the long-term safety and efficacy of  
dupilumab in treating pediatric patients with atopic 
dermatitis, as well as any possible negative effects and 
overall disease control.

➢ Evaluate the Effectiveness, safety, and tolerability 
of  Dupilumab compared to other biologic drugs in 
pediatric atopic dermatitis therapy, such as Tralokinumab 
or Omalizumab.

LIMITATIONS
➢ The severity of  atopic dermatitis in children 

significantly influenced the response to Dupilumab 
treatment, making it challenging to draw definitive 
conclusions.

➢ Dupilumab treatment’s high cost and accessibility 
issues in certain healthcare settings caused hindrances in 
its widespread adoption and data availability in research 
studies.

REFERENCES 
Albrecht, M., & Dittrich, A. (2015). Expression and 

function of  histamine and its receptors in atopic 
dermatitis. Molecular and cellular pediatrics, 2, 1-8. 

Amber, T., & Tabassum, S. (2020). Cyclosporin in 
dermatology: A practical compendium. Dermatologic 
Therapy, 33(6), e13934. 

Anderson III, W. C., & Szefler, S. J. (2019). Cost-
effectiveness and comparative effectiveness of  
biologic therapy for asthma: to biologic or not to 
biologic? Annals of  Allergy, Asthma & Immunology, 
122(4), 367-372. 

Antti, A., Salava, A., Perälä, M., Pelkonen, A. S., Mäkelä, M. 
J., & Remitz, A. (2021). Are infants and toddlers with 
moderate-to-severe atopic dermatitis undertreated? 
Experiences of  a Finnish tertiary care hospital. Acta 
Dermato-Venereologica, 101(1). 

Axon, E., Chalmers, J. R., Santer, M., Ridd, M. J., Lawton, 
S., Langan, S. M., Grindlay, D. J., Muller, I., Roberts, A., 
& Ahmed, A. (2021). Safety of  topical corticosteroids 
in atopic eczema: an umbrella review. BMJ open, 11(7), 
e046476. 

Berna-Rico, E., Fiz-Benito, E., Busto-Leis, J. M., Servera-
Negre, G., de Lucas-Laguna, R., & Feito-Rodriguez, 
M. (2023). Effectiveness and safety of  dupilumab 
in children under 6 years of  age with moderate-to-
severe atopic dermatitis: a retrospective real-world 
study. Dermatology, 1-1. 

Berth-Jones, J., Damstra, R. J., Golsch, S., Livden, J. K., 
Van Hooteghem, O., Allegra, F., & Parker, C. A. 
(2003). Twice weekly fluticasone propionate added 
to emollient maintenance treatment to reduce risk 
of  relapse in atopic dermatitis: randomised, double 
blind, parallel group study. Bmj, 326(7403), 1367. 

Bohannon, M., Liu, M., Nadeau, P., Talton, J., Gibson, 
D., Datta, S., Schultz, G., Talton, J., & De Benedetto, 
A. (2020). Topical doxycycline monohydrate hydrogel 
1% targeting proteases/PAR2 pathway is a novel 
therapeutic for atopic dermatitis. Experimental 
dermatology, 29(12), 1171-1175. 

Caffarelli, C., Giannetti, A., Giannì, G., & Ricci, G. 
(2023). Anti-inflammatory and biologic drugs for 
atopic dermatitis: a therapeutic approach in children 
and adolescents. Frontiers in Medicine, 10. 

Choi, C. W., Yang, B. R., Suh, D. I., Kim, M. S., Ohn, J., 
Hong, J. S., Lee, J., & Kim, K. H. (2020). Infection, 
antibiotic exposure and development of  atopic 
dermatitis: A nationwide case–control study. The 



Pa
ge

 
67

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

Journal of  dermatology, 47(7), 707-713. 
Chovatiya, R., & Silverberg, J. I. (2019). Pathophysiology 

of  atopic dermatitis and psoriasis: implications for 
management in children. Children, 6(10), 108. 

Chu, A. W., Wong, M. M., Rayner, D. G., Guyatt, G. H., 
Martinez, J. P. D., Ceccacci, R., Zhao, I. X., McMullen, 
E., Srivastava, A., & Wang, J. (2023). Systemic 
treatments for atopic dermatitis (eczema): systematic 
review and network meta-analysis of  randomized 
trials. Journal of  Allergy and Clinical Immunology, 152(6), 
1470-1492. 

Class, I., Class, I., & Class, I. (2022). Systemic antibiotic 
prophylaxis for recurrent infective flares in children 
and adolescents with atopic dermatitis. Ann Acad Med 
Singap, 51(2), 113-114. 

Cork, M. J., Danby, S. G., Rossi, A. B., & Bansal, A. (2024). 
Dupilumab Treatment in Pediatric Patients Aged 6–11 
Years with Severe Atopic Dermatitis Whose Disease 
Is Not Adequately Controlled: A Review. Drug Design, 
Development and Therapy, 277-289. 

Coskey, R. J. (1978). Contact dermatitis due to clindamycin. 
Archives of  Dermatology, 114(3), 446-446. 

Deleanu, D., & Nedelea, I. (2019). Biological therapies 
for atopic dermatitis: An update. Experimental and 
therapeutic medicine, 17(2), 1061-1067. 

Dhamija, S., Patel, R., Pol, S. A., Kulkarni, S., & Yamagar, 
N. (2024). Comparing Treatment Outcome of  
Allergic Rhinitis Patients After Using Fluticasone 
Nasal Spray and Nasal Douching. Journal of  Clinical 
Otorhinolaryngology, 6(1). 

Drucker, A., Eyerich, K., de Bruin‐Weller, M., Thyssen, 
J. P., Spuls, P., Irvine, A., Girolomoni, G., Dhar, S., 
Flohr, C., & Murrell, D. (2018). Use of  systemic 
corticosteroids for atopic dermatitis: International 
Eczema Council consensus statement. British Journal 
of  Dermatology, 178(3), 768-775. 

Drug Trials Snapshots: DUPIXENT (2017).  Food And 
Drug Administration. 

FDA. (2019). BLA Multi-Disciplinary review and 
Evaluation. Food and drug administration. 

Ferrucci, S. M., Tavecchio, S., Marzano, A. V., & Buffon, 
S. (2023). Emerging systemic treatments for atopic 
dermatitis. Dermatology and Therapy, 13(5), 1071-1081. 

Frazier, W., & Bhardwaj, N. (2020). Atopic dermatitis: 
diagnosis and treatment. American family physician, 
101(10), 590-598. 

Grobe, W., Bieber, T., & Novak, N. (2019). 
Pathophysiology of  atopic dermatitis. JDDG: Journal 
der deutschen dermatologischen Gesellschaft, 17(4), 433-440. 

Haeck, I. M., Rouwen, T. J., Timmer-de Mik, L., de Bruin-
Weller, M. S., & Bruijnzeel-Koomen, C. A. (2011). 
Topical corticosteroids in atopic dermatitis and the 
risk of  glaucoma and cataracts. Journal of  the American 
Academy of  Dermatology, 64(2), 275-281. 

Harvey, J., Lax, S. J., Lowe, A., Santer, M., Lawton, S., 
Langan, S. M., Roberts, A., Stuart, B., Williams, H. 
C., & Thomas, K. S. (2023). The long‐term safety 
of  topical corticosteroids in atopic dermatitis: A 

systematic review. Skin Health and Disease, 3(5), e268. 
Hon, K. L. E., Chan, V. P., & Leung, A. K. (2021). 

Experimental drugs with the potential to treat atopic 
eczema. Journal of  experimental pharmacology, 487-498. 

Hulme, J. (2023). Staphylococcus Infection: Relapsing 
Atopic Dermatitis and Microbial Restoration. 
Antibiotics, 12(2), 222. 

Kamal, M. A., Kovalenko, P., Kosloski, M. P., Srinivasan, 
K., Zhang, Y., Rajadhyaksha, M., Lai, C. H., 
Kanamaluru, V., Xu, C., & Sun, X. (2021). The 
posology of  dupilumab in pediatric patients with 
atopic dermatitis. Clinical Pharmacology & Therapeutics, 
110(5), 1318-1328. 

Kamphuis, E., Boesjes, C. M., Loman, L., Bakker, D. 
S., Poelhekken, M., Zuithoff, N. P., Kamsteeg, M., 
Romeijn, G. L., van Wijk, F., & de Bruin‐Weller, M. S. 
(2022). Dupilumab in daily practice for the treatment 
of  pediatric atopic dermatitis: 28‐week clinical and 
biomarker results from the BioDay registry. Pediatric 
Allergy and Immunology, 33(12), e13887. 

Kim, J., Kim, B. E., & Leung, D. Y. (2019). Pathophysiology 
of  atopic dermatitis: Clinical implications. Allergy and 
asthma proceedings, 

Kraft, M., & Worm, M. (2017). Dupilumab in the 
treatment of  moderate-to-severe atopic dermatitis. 
Expert review of  clinical immunology, 13(4), 301-310. 

Lee, J. H., Yun, S.-J., Lee, J.-B., & Lee, S.-C. (2020). 
Therapeutic efficacy and safety of  methotrexate in 
moderate-to-severe atopic dermatitis: a retrospective 
study of  Korean patients at tertiary referral hospital. 
Annals of  Dermatology, 32(5), 402. 

Li, Y., Jing, D., Huang, Y., Su, J., Li, J., Li, J., Tao, J., Shan, 
S., Wang, X., & Kang, X. (2021). Association of  
antibiotics use in preschool age with atopic and allergic 
skin diseases in young adulthood: a population-based 
retrospective cohort study. BMJ open, 11(9), e047768. 

Mandlik, D. S., & Mandlik, S. K. (2021). Atopic dermatitis: 
new insight into the etiology, pathogenesis, diagnosis 
and novel treatment strategies. Immunopharmacology and 
immunotoxicology, 43(2), 105-125. 

Martins, J. C., Martins, C., Aoki, V., Gois, A. F., Ishii, H. 
A., & da Silva, E. M. (2015). Topical tacrolimus for 
atopic dermatitis. Cochrane Database of  Systematic 
Reviews(7). 

Megna, M., Napolitano, M., Patruno, C., Villani, A., 
Balato, A., Monfrecola, G., Ayala, F., & Balato, N. 
(2017). Systemic treatment of  adult atopic dermatitis: 
a review. Dermatology and Therapy, 7, 1-23. 

Mehta, Y., & Fulmali, D. G. (2022). Relationship between 
atopic dermatitis and food allergy in children. Cureus, 
14(12). 

Montes-Torres, A., Llamas-Velasco, M., Pérez-Plaza, 
A., Solano-López, G., & Sánchez-Pérez, J. (2015). 
Biological treatments in atopic dermatitis. Journal of  
Clinical Medicine, 4(4), 593-613. 

Mose, A. P., Usamah, A., & Svedman, C. (2022). Allergic 
contact dermatitis to topical clindamycin in a patient 
with hidradenitis suppurativa. Acta Dermato-



Pa
ge

 
68

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(1) 61-68, 2024

Venereologica, 102. 
Mubanga, M., Lundholm, C., D’Onofrio, B. M., 

Stratmann, M., Hedman, A., & Almqvist, C. (2021). 
Association of  early life exposure to antibiotics with 
risk of  atopic dermatitis in Sweden. JAMA Network 
open, 4(4), e215245-e215245. 

Nakahara, T., Kido‐Nakahara, M., Tsuji, G., & Furue, 
M. (2021). Basics and recent advances in the 
pathophysiology of  atopic dermatitis. The Journal of  
dermatology, 48(2), 130-139. 

Napolitano, M., Fabbrocini, G., Neri, I., Stingeni, L., 
Boccaletti, V., Piccolo, V., Amoruso, G. F., Malara, G., 
De Pasquale, R., & Di Brizzi, E. V. (2022). Dupilumab 
treatment in children aged 6–11 years with atopic 
dermatitis: a multicentre, real-life study. Pediatric Drugs, 
24(6), 671-678. 

Neri, L. (2015). Antibiotic therapy in the management 
of  atopic dermatitis. Giornale italiano di dermatologia e 
venereologia: organo ufficiale, Societa italiana di dermatologia e 
sifilografia, 150(3), 321-325. 

Nicholas, M. N., Keown-Stoneman, C. D., Maguire, J. L., 
& Drucker, A. M. (2022). Association between atopic 
dermatitis and height, body mass index, and weight in 
children. JAMA dermatology, 158(1), 26-32. 

Ohsawa, Y., & Hirasawa, N. (2014). The role of  histamine 
H1 and H4 receptors in atopic dermatitis: from basic 
research to clinical study. Allergology International, 63(4), 
533-542. 

Paolino, A., Alexander, H., Broderick, C., & Flohr, 
C. (2023). Non‐biologic systemic treatments for 
atopic dermatitis: current state of  the art and future 
directions. Clinical & Experimental Allergy, 53(5), 495-
510. 

Papp, K. A., Hong, C.-h., Lansang, M. P., Turchin, 
I., Adam, D. N., Beecker, J. R., Bissonnette, R., 
Gooderham, M. J., Jack, C., & Joseph, M. (2021). 
Practical management of  patients with atopic 
dermatitis on dupilumab. Dermatology and Therapy, 11, 
1805-1828. 

Phan, K., & Smith, S. D. (2020). Mycophenolate mofetil 
and atopic dermatitis: systematic review and meta-
analysis. Journal of  Dermatological Treatment, 31(8), 810-
814. 

Rajagopalan, M., Saraswat, A., Chandrashekar, B. S., 
Dhar, S., Dogra, S., Tahiliani, S., & Raj, P. (2022). Role 
of  cyclosporine (CsA) in immuno-dermatological 
conditions. Indian Dermatology Online Journal, 13(5), 
585-599. 

Rist, T., Parish, L., Capin, L., Sulica, V., Bushnell, W., & 
Cupo, M. (2002). A comparison of  the efficacy and 
safety of  mupirocin cream and cephalexin in the 
treatment of  secondarily infected eczema. Clinical and 
experimental dermatology, 27(1), 14-20. 

Rusiñol, L., & Puig, L. (2024). Multi-Omics Approach 
to Improved Diagnosis and Treatment of  Atopic 
Dermatitis and Psoriasis. International Journal of  
Molecular Sciences, 25(2), 1042. 

Schaper‐Gerhardt, K., Rossbach, K., Nikolouli, E., 
Werfel, T., Gutzmer, R., & Mommert, S. (2020). The 
role of  the histamine H4 receptor in atopic dermatitis 
and psoriasis. British journal of  pharmacology, 177(3), 
490-502. 

Shah, N., Alhusayen, R., Walsh, S., & Shear, N. H. (2018). 
Methotrexate in the treatment of  moderate to severe 
atopic dermatitis: a retrospective study. Journal of  
cutaneous medicine and surgery, 22(5), 484-487. 

Soares, G. B., Hashimoto, T., & Yosipovitch, G. (2024). 
Atopic Dermatitis Itch: Scratching for an Explanation. 
Journal of  Investigative Dermatology. 

Sonya Kahn, M., Rind, D., Chapman, R., Kumar, V., Kahn, 
S., & Carlson, J. (2018). Economic evaluation of  
dupilumab for moderate-to-severe atopic dermatitis: 
a cost-utility analysis. J Drugs Dermatol, 17(7), 750-756. 

Stacey, S. K., & McEleney, M. (2021). Topical 
corticosteroids: choice and application. American 
family physician, 103(6), 337-343. 

Study of  Dupilumab. (2017).  Clinical trials. gov. 
Subramanian, I., Singh, V. K., & Jere, A. (2018). 

Elucidating mechanistic insights into drug action for 
atopic dermatitis: a systems biology approach. BMC 
dermatology, 18, 1-12. 

Umar, B. U., Rahman, S., Dutta, S., Islam, T., Nusrat, N., 
Chowdhury, K., Ahmad, W. F. S. B. W., Haque, M., 
Umar, B. U. U., & Fakuradzi, W. F. S. W. A. (2022). 
Management of  atopic dermatitis: the role of  
tacrolimus. Cureus, 14(8). 

Xu, X., van Galen, L. S., Koh, M. J. A., Bajpai, R., Thng, 
S., Yew, Y. W., Ho, V. P. Y., Alagappan, U., Järbrink, 
K. S. A., & Car, J. (2019). Factors influencing quality 
of  life in children with atopic dermatitis and their 
caregivers: a cross-sectional study. Scientific Reports, 
9(1), 15990. 

Zhou, S., Qi, F., Gong, Y., Zhang, J., & Zhu, B. (2021). 
Biological therapies for atopic dermatitis: a systematic 
review. Dermatology, 237(4), 542-552.


