Monoclonal Antibodies in Pediatric Atopic Dermatitis; Efficacy and Safety

Atopic dermatitis (AD), which causes eczema, dryness, and itching, is one of the most prevalent skin diseases in children. Along with topical corticosteroids and the liberal application of emollients, monoclonal antibodies have recently been used for systemic treatment in moderate to severe cases. This study aims to review the current literature on the application of monoclonal antibodies (mAbs) in treating children with AD.

To conduct a narrative review of the literature, we searched for the keywords (monoclonal antibodies OR biologics) AND (pediatric OR children) AND (atopic dermatitis OR eczema) in PubMed and Google Scholar.

The pathophysiology of atopic dermatitis still requires better understanding (or, remains incompletely understood). The most well-known factors contributing to the pathophysiology of AD include filaggrin gene mutations and abnormalities in Th1 and Th2 cell regulation. Cytokines, such as IL-4, IL-13, IL-17, IL-22, IL-31, and IL-33, are crucial mediators that lead to IgE antibody production and result in skin barrier degradation. Monoclonal antibodies have several advantages over other systemic therapies. Among these, dupilumab, tralokinumab, omalizumab, nemolizumab, lebrikizumab, and benralizumab have shown favorable results.

A systemic immunomodulatory medication (monoclonal antibodies) is frequently required for moderate to severe AD as supplementary treatment. Dupilumab has received FDA approval for pediatric AD. Further clinical trials are needed for other mAbs before they are used in children.