Yes, there are injectable treatments for eczema. Several biologic medications given as shots under the skin are now FDA-approved for moderate-to-severe atopic dermatitis, and they can dramatically reduce itching and skin inflammation when creams and ointments aren’t enough. The most established is dupilumab (Dupixent), approved since 2017, with newer options now available as well.
How Eczema Shots Work
Eczema flares are driven by an overactive immune response, specifically by two signaling molecules called IL-4 and IL-13. These molecules trigger the cascade of inflammation that leads to red, itchy, cracked skin. Biologic shots are lab-made antibodies designed to block these signals at their source, calming the immune overreaction rather than just suppressing symptoms on the surface.
This targeted approach is what sets biologics apart from older systemic treatments that broadly dampen the immune system. By zeroing in on the specific pathway behind eczema inflammation, the shots reduce skin symptoms without as much collateral impact on your overall immune defenses.
Which Shots Are Available
Dupilumab (Dupixent) remains the most widely prescribed and studied biologic for eczema. It blocks both IL-4 and IL-13 and is approved for patients as young as 6 months old, making it the only biologic available across nearly all age groups. For adults, the typical schedule is a loading dose of two injections on day one, followed by one injection every two weeks.
Tralokinumab (Adbry) is a second biologic option that specifically targets IL-13. It’s approved for adults with moderate-to-severe eczema.
The newest addition is nemolizumab (Nemluvio), which works differently from the others. Instead of targeting IL-4 or IL-13, it blocks a signaling molecule called IL-31 that plays a major role in itch. It’s approved for adults and children 12 and older with moderate-to-severe eczema, used alongside topical treatments like prescription steroid creams or calcineurin inhibitors.
How Well the Shots Work
The results from clinical trials and long-term follow-up studies are strong. In a five-year study of dupilumab published in JAMA Dermatology, 88.9% of patients achieved at least 75% improvement in their eczema severity score, and 67.5% reached skin that was clear or almost clear. Those numbers continued improving over the full five years, suggesting the medication doesn’t lose effectiveness with continued use.
Nemolizumab showed more modest initial numbers in its pivotal trials, with 36% to 38% of patients reaching clear or almost-clear skin at 16 weeks compared to 25% to 26% on placebo. By 48 weeks, around 63% of patients on nemolizumab achieved that level of clearance. Its particular strength is itch relief: roughly twice as many patients on nemolizumab experienced meaningful itch reduction compared to placebo.
What Getting the Shots Looks Like
These are all self-administered injections, similar to what people with diabetes do with insulin. You inject under the skin of your thigh or abdomen (avoiding the area right around the navel). If a caregiver is giving the shot, the upper arm is also an option. You rotate the injection site each time.
For dupilumab in adults, after the initial loading dose, you give yourself one shot every two weeks. Children on lower weight-based doses may only need an injection every four weeks. The shots come in prefilled syringes, and most people learn the technique quickly at their first appointment.
Possible Side Effects
The most notable side effect of biologic eczema shots is eye-related symptoms, particularly conjunctivitis (pink eye). A meta-analysis covering nearly 5,800 patients found that those on biologics were about three times more likely to develop conjunctivitis than those on placebo. The most common complaints are dry eyes and eye itching. This side effect occurs across all the available biologics at similar rates.
Injection site reactions, like redness or mild swelling where the needle goes in, are common but generally mild and tend to decrease over time. Compared to oral eczema medications (JAK inhibitors like upadacitinib), biologics have a notably different side effect profile. Oral medications carry higher rates of infections, acne, and stomach issues, while biologics are more likely to cause eye symptoms. Biologics also tend to have longer treatment persistence, meaning people stay on them longer before needing to switch, with an average treatment duration roughly twice that of oral options in real-world data.
Shots vs. Oral Medications
JAK inhibitor pills work faster in the first few months. At 16 weeks, about 74% of patients on JAK inhibitors hit the 75% improvement mark compared to 57% on biologics. But biologics catch up and pull ahead over time. By one year, the total improvement in eczema scores was significantly greater with biologics. People also stayed on biologics an average of about 27 months compared to roughly 15 months for oral medications, partly because of fewer side effect concerns with long-term use.
The choice between shots and pills often comes down to how quickly you need relief, your comfort with injections versus daily pills, and your individual risk factors. Both are reserved for moderate-to-severe eczema that hasn’t responded to topical treatments alone.
Who Qualifies for Eczema Shots
The FDA approved these biologics for people whose eczema isn’t adequately controlled with topical prescription therapies. In practice, though, your insurance plan determines what hoops you need to jump through. Coverage policies vary widely.
Common requirements include having at least 10% of your body surface area affected (roughly the area of one arm), or having eczema in sensitive areas like the face, hands, or genitals. Most plans also require a severity rating of moderate or higher on a clinical scale. Nearly all insurers require step therapy, meaning you need to have tried and failed other treatments first. Some plans require just one failed topical steroid, while others demand you try multiple topical steroids, a calcineurin inhibitor cream, and even phototherapy or an oral immunosuppressant before approving a biologic.
The list price for these medications is significant. Dupilumab runs roughly $25,000 to $26,000 per year, and tralokinumab is in a similar range. Most manufacturers offer copay assistance programs for commercially insured patients, and patient assistance programs for those who are uninsured or underinsured. With insurance and copay cards, many patients pay substantially less out of pocket, though the exact amount depends on your plan.
What to Expect After Starting
Most people notice improvement within the first few weeks, though the full benefit builds over months. Itch relief often comes before visible skin clearing. In clinical practice, doctors typically evaluate whether the shot is working at around 16 weeks. If you’re responding well, you’ll likely continue indefinitely, as eczema is a chronic condition and symptoms generally return if you stop treatment. The five-year dupilumab data suggests that results continue to improve or hold steady with ongoing use, with no new safety concerns emerging over that period.