What Are Immunomodulators?

In people with atopic dermatitis (AD), also known as atopic dermatitis, there is a dysfunction in the immune system, which results in an overactive, inflammatory state. Because of this dysfunction in the immune system, treatment with immunomodulators may be appropriate for individuals with severe AD. Immunomodulators suppress or interfere with the immune system response and may indirectly improve the function of the skin barrier and reduce the symptoms of AD, including itching, redness, and rash.

Immunomodulators are a systemic treatment, meaning they work on the whole body and not just one particular area like topical treatments do. Systemic treatments like immunomodulators do not rule out the need for topical treatments, especially good skin care. Good skin care, including the frequent use of moisturizers, is always a necessary component in the treatment of AD. The American Academy of Dermatology states that immunomodulators are recommended for adult and pediatric patients whose disease is not controlled through the use of emollients, topical therapies, and/or phototherapy, as well as those patients whose medical, physical, or psychological states are greatly affected by their skin disease.1,2

Types of immunomodulators

There are a couple different medications used in the treatment of AD that are classified as immunomodulators, including: corticosteroids and dupilumab.

Corticosteroids

Systemic corticosteroids reduce the production of the chemicals that cause inflammation. Short-term use of systemic corticosteroids can help in severe exacerbations of AD, including severe itching, however they have not been shown to control symptoms or induce remission long-term. Systemic corticosteroids have significant potential side effects, including diabetes, high blood pressure, gastric ulcers, osteoporosis, skin thinning (atrophy), glaucoma, and growth retardation.1 There is also a potential risk for disease rebound when systemic steroids are discontinued.

Dupilumab

Dupilumab is a human monoclonal antibody, a type of protein that is made to attach to a particular substance. Marketed as Dupixent® (dupilumab) injection, it targets interleukin-4 (IL-4) and interleukin-13 (IL-13), two chemicals that are involved in the inflammatory response of the immune system.2,3

Before using immunomodulators

Because immunomodulators affect the entire body, individuals must receive a clinical and laboratory work-up to ensure they do not have active, infectious diseases, including hepatitis B and C or HIV infection. In addition, organ function tests may be needed before and during therapy with certain drugs.1

Emily Downward | June 2017
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