Where dupilumab sits now
Dupilumab (Dupixent) is FDA-approved from 6 months of age, and remains the most widely used. The AAD notes that it does not suppress the immune system, so it does not increase the risk of developing a serious infection such as tuberculosis. Commonly reported side effects are a mild skin reaction at the injection site, inflamed or itchy eyes or eyelids, and cold sores. Our guide on living with a biologic day to day covers what it's actually like to be on one.
Tralokinumab (Adbry) and lebrikizumab (Ebglyss)
Both are IL-13 inhibitors — a narrower target than dupilumab's. Both are approved from age 12 and up, with a minimum weight requirement of 88 pounds. The common side effects listed for both are conjunctivitis — inflamed, itchy eyes — and a skin reaction where the injection was given.
The eye side effect is worth knowing about in advance rather than being surprised by; it is common enough across this family of treatments to be on our radar in eczema and eye health.
Nemolizumab (Nemluvio) — the one aimed at itch
Nemolizumab targets the IL-31 receptor, which carries the non-histamine itch signal. That is a different target from everything above: rather than calming the inflammation and waiting for the itch to follow, it goes at the itch pathway itself. Approved from age 12 and up, and some patients report noticeable relief from itch within the first week. Common side effects listed: headache, joint pain, and hives.
If your honest answer to "what is the worst part?" is the itch rather than the appearance, that distinction is worth raising by name at your appointment.
What the 2025 guideline says
The AAD's 2025 focused update on atopic dermatitis in adults developed strong recommendations for lebrikizumab and nemolizumab used with concomitant topical therapy, alongside tapinarof and roflumilast creams. In other words, these are not experimental edge cases — they are part of the recommended landscape now.
Choosing between them isn't a reading exercise
Which of these — if any — suits you depends on your age and weight, your severity, what you have already tried, your eye history, other conditions you have, and what your insurance will actually cover. That last one is not a small factor in the US, and our guide on prior authorization and appeals is there because it so often becomes the deciding one.
What this page is for is walking into that conversation knowing the options exist and having a question ready.
Give the next decision something to stand on
Every one of these conversations starts with “how bad is it, really, and what have you tried?” Ollowen answers both from your own record — months of skin, sleep and treatments in one page, instead of a summary assembled in the waiting room.
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Sources
- American Academy of Dermatology. Atopic dermatitis: diagnosis and treatment.
- American Academy of Dermatology. Atopic dermatitis clinical guidelines (2025 focused update).
- Focused update: guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol, 2025.
- Current and emerging biologics for atopic dermatitis.
More Ollowen guides: see all →