Are biologic injections for eczema safe for my 9-year-old daughter?

Question

Hello doctor,

My 9-year-old daughter has had severe eczema since childhood. Her skin is always itchy, with red patches on her arms and behind her knees. We use moisturizers daily and steroid creams during flare-ups, but the effects do not last. Sometimes she scratches until it bleeds. I have read about new biologic injections for children. Are they safe? Could food allergies be triggering her eczema?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your daughter’s symptoms are consistent with moderate-to-severe atopic dermatitis (eczema). At her age, breaking the itch–scratch cycle early is essential to reduce the risk of skin infections and long-term skin thickening (lichenification). Below is a connected overview to help you understand her condition and treatment options.

Why eczema persists:Her skin has a barrier defect, meaning it loses moisture easily, leading to dryness, itching, scratching, and ongoing inflammation. In addition, her immune system is overactive, so triggers such as allergens, dust mites, and weather changes can cause frequent flare-ups. Scratching to the point of bleeding further increases the risk of secondary bacterial infections, especially staphylococcal infections.
Role of food allergies:In some children, food allergies may worsen eczema, particularly if flares are noticed after consuming milk, eggs, soy, peanuts, or wheat. However, not all children with eczema have food allergies.Best approach: Maintain a food–symptom diary and discuss allergy testing, such as an allergy panel or skin prick test, with your doctor before eliminating major foods. Avoid unnecessary dietary restrictions.
Current standard treatment:Since moisturizers and steroid creams alone are not giving adequate control, a step-up approach is needed.Daily care includes using a thick, fragrance-free moisturizer two to three times daily, especially immediately after bathing, along with short, lukewarm baths and gentle cleansers while avoiding harsh soaps.Steroids should be low- to mid-potency, used only during flare-ups for five to seven days, then tapered, as overuse can cause skin thinning in children.Non-steroidal, steroid-sparing creams such as Tacrolimus 0.03 percent or Pimecrolimus 1 percent are safe for long-term use, particularly on sensitive areas like the face and skin folds.
Biologic injections for children:There are now FDA-approved biologic treatments for pediatric eczema when it is moderate-to-severe and not responding adequately to topical therapy. Dupilumab (Dupixent) is approved for children six months and older. It works by calming the overactive immune pathways involving interleukin-4 and interleukin-13 and is given as a subcutaneous injection every two to four weeks. In terms of safety, it is much safer than long-term steroids or oral immunosuppressants. The most common side effects are mild injection site reactions and occasional eye irritation. Many children experience significant improvement in itching, flare control, and overall quality of life.
When to consider biologic therapy:It is considered when there is extensive skin involvement, sleep disturbance due to itching, frequent steroid use, or poor response to topical treatment, or a significant psychosocial impact, such as school embarrassment or low confidence.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.