Dupilumab is an injectable biologic that may be considered for moderate to severe atopic dermatitis in patients aged 6 months and above. This monoclonal antibody works by inhibiting IL-4 and IL-13 signalling, which are involved in type 2 inflammation associated with eczema. The medication is delivered through prefilled syringes or auto-injectors, and self-administration may be possible after appropriate training. Treatment typically involves an initial loading dose followed by injections every two weeks.
Eczema Injections in Singapore
Dr. Liew Hui Min
Living with severe eczema can impact quality of life, from persistent itching and inflammation to sleep disruption and social discomfort. For patients who have not found adequate relief through conventional treatments, eczema injections may offer a targeted approach to managing moderate to severe atopic dermatitis. These injectable treatments work by addressing the underlying immune responses that drive eczema symptoms, and may provide relief when topical treatments and oral medications prove insufficient. Individual results and timelines may vary.
What are Eczema Injections?
Eczema injections are biologic medications given through subcutaneous injection to treat moderate to severe atopic dermatitis (eczema). These injectable treatments include several HSA-approved monoclonal antibodies that target specific proteins involved in eczema inflammation. Unlike traditional treatments that suppress the entire immune system, these targeted biologics block specific inflammatory pathways that drive the symptoms of eczema.
Available Injectable Treatments in Singapore:
Dupilumab: A monoclonal antibody that inhibits both interleukin-4 (IL-4) and interleukin-13 (IL-13) signalling, two key proteins involved in type 2 inflammation associated with eczema. This treatment is approved for patients aged 6 months and above with moderate to severe atopic dermatitis.
Lebrikizumab: An HSA-approved monoclonal antibody that specifically targets interleukin-13 (IL-13). This treatment is indicated for patients aged 12 years and above with moderate to severe atopic dermatitis who may be candidates for systemic therapy. Lebrikizumab offers an alternative mechanism of action by selectively inhibiting IL-13 signalling.
Nemolizumab: An HSA-approved monoclonal antibody that targets the interleukin-31 receptor alpha (IL-31RA), a pathway specifically associated with pruritus (itching) in atopic dermatitis. This treatment is approved for patients aged 12 years and above with moderate to severe atopic dermatitis and may be particularly considered for patients experiencing significant itch symptoms.
These injections represent advances in eczema treatment, particularly for patients whose condition has not responded adequately to topical corticosteroids, moisturisers, or systemic immunosuppressants. Treatment frequency and protocols vary by medication, with some requiring administration every two weeks and others every four weeks after initial loading doses, allowing for sustained management of eczema symptoms. These treatments may help improve skin clearance, reduce itching, and enhance quality of life.
Who is a Suitable Candidate?
Potential Candidates
- Adults and adolescents (12 years and above) with moderate to severe atopic dermatitis (for all three HSA-approved biologics)
- Children aged 6 months and above (for dupilumab specifically)
- Patients who have not achieved adequate control with topical prescription therapies
- Individuals whose eczema impacts daily activities, sleep, or work performance
- Those who have tried conventional treatments without sufficient improvement
- Patients who cannot tolerate or have contraindications to systemic immunosuppressants
- Individuals with extensive eczema coverage
- Those experiencing frequent flare-ups despite consistent treatment adherence
- Patients with predominant pruritus (itching) symptoms may be considered for treatments targeting specific itch pathways
Contraindications
- Known hypersensitivity to the biologic medication or any of its components
- Active parasitic (helminth) infections until properly treated
- Live vaccines should be avoided during treatment
- Certain eye conditions may require ophthalmologic monitoring (particularly with some biologics)
- Pregnancy and breastfeeding require careful risk-benefit assessment
- Specific contraindications may vary by medication
Your dermatologist may conduct a thorough assessment of your medical history, current medications, symptom profile, and eczema severity to determine which injectable treatment, if any, may be appropriate for your specific situation. This evaluation includes examining the extent and severity of your eczema, reviewing previous treatment responses, assessing your predominant symptoms (such as itch intensity), and discussing your treatment goals.
Individual suitability varies based on medical history and clinical assessment.
Treatment Techniques & Approaches
Several HSA-approved biologic injections may be considered for moderate to severe atopic dermatitis in suitable candidates. Each treatment works through distinct mechanisms to address the underlying inflammatory processes in eczema.
Dupilumab Injection Therapy
Lebrikizumab Injection Therapy
Lebrikizumab is an HSA-approved injectable biologic for moderate to severe atopic dermatitis in patients aged 12 years and above. This monoclonal antibody specifically targets and inhibits IL-13, a key cytokine in the type 2 inflammatory pathway. By selectively blocking IL-13, lebrikizumab offers a distinct mechanism compared to treatments that target multiple interleukins. The medication is administered via subcutaneous injection, with a specific 16 week loading and monthly maintenance dosing schedule determined by your dermatologist.
Nemolizumab Injection Therapy
Nemolizumab is an HSA-approved injectable biologic for moderate to severe atopic dermatitis in patients aged 12 years and above. Unlike other biologics that primarily target inflammatory cytokines, nemolizumab specifically blocks the interleukin-31 receptor alpha (IL-31RA), a pathway closely associated with the sensation of itch in atopic dermatitis. This treatment may be particularly relevant for patients whose primary concern is severe pruritus. The medication is delivered through subcutaneous injection, with a monthly maintenance dosing schedule.
Administration Methods
These injections are given subcutaneously, typically in the thigh, abdomen, or upper arm. Depending on the specific medication, patients may receive initial loading doses followed by regular maintenance injections at intervals ranging from every two weeks to every four weeks. The injection sites should be rotated to prevent irritation, avoiding areas where the skin is tender, bruised, or affected by eczema. After appropriate training, many patients can self-administer their injections at home.
Technology & Equipment Used
Modern auto-injector devices can make the administration process more convenient for patients. These devices feature safety mechanisms to help prevent needle stick injuries and support proper dose delivery. The medications are stored in refrigerated conditions and brought to room temperature before injection to help minimise discomfort. Your dermatologist may provide specific storage and handling instructions for your prescribed medication.
Wondering which approach might be suitable for you?
Our dermatologist can evaluate your specific needs and discuss available treatment options.
The Treatment Process
Pre-Treatment Preparation
Before starting eczema injections, your dermatologist can conduct comprehensive baseline assessments including skin examination, photography for progress monitoring, and blood tests if necessary. You’ll receive detailed injection training for self-administration or caregiver administration. Any active infections should be treated before beginning therapy. Continue your current skincare routine unless otherwise advised, and to confirm that all vaccinations are up to date, as live vaccines should be completed before starting treatment.
During the Procedure
The injection process takes only a few seconds. After cleaning the injection site with an alcohol swab, the medication is administered using either a prefilled syringe or auto-injector. The needle is inserted at a 45-90 degree angle into the fatty tissue beneath the skin. Patients may feel a slight pinch or sting that subsides quickly. The entire appointment, including preparation and observation, may take 15-30 minutes for the first few sessions.
Immediate Post-Treatment
After injection, gentle pressure is applied to the site with a cotton ball or gauze. Minor bleeding or bruising at the injection site is normal. You can resume normal activities immediately after the injection. Some patients may experience mild injection site reactions such as redness or swelling, which may resolve within a few hours. Your dermatologist may monitor you briefly after your first injection to ensure no immediate adverse reactions occur.
Recovery & Aftercare
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First 24-48 Hours
Monitor the injection site for any unusual reactions beyond mild redness or swelling. Continue your regular skincare routine, including moisturisers and any prescribed topical treatments. Stay hydrated and avoid excessive sun exposure. If you experience concerning symptoms such as difficulty breathing, severe rash, or swelling of the face or throat, seek immediate medical attention.
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First Week
Continue to rotate injection sites as instructed to prevent skin irritation. Maintain a consistent skincare routine with gentle, fragrance-free products. Some patients may notice initial improvements in itching, though skin clearance may take longer. Keep track of any changes in your eczema symptoms or side effects in a diary to discuss at your next appointment. Avoid new skincare products or potential triggers during this adjustment period.
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Long-term Recovery
Improvement in eczema symptoms may occur over time with continued treatment. Regular follow-up appointments allow your dermatologist to monitor treatment effectiveness and adjust the plan if needed. Some patients may be able to reduce other systemic medications once the injections show effectiveness.
Our dermatologist provides post-procedure support to help with recovery.
Schedule your consultation to learn more about what to expect.
Benefits of Eczema Injections
Injectable eczema treatments may offer benefits for suitable patients. The targeted mechanism of action may result in fewer systemic side effects compared to traditional immunosuppressants. Patients may experience improvements in sleep quality due to reduced nighttime itching, which can support better daytime functioning.
The treatment may also reduce the need for topical corticosteroids, potentially minimising concerns about skin thinning or other steroid-related side effects. Some patients may experience improvements in associated conditions like asthma or allergic rhinitis, as these conditions share similar inflammatory pathways. The convenience of regular self-administration can eliminate the need for frequent clinic visits, making it easier to maintain consistent treatment. Quality of life improvements may extend beyond skin clearance to include reduced anxiety and enhanced ability to participate in work and social activities.
Risks & Potential Complications
Common Side Effects
Side effects may include injection site reactions such as redness, swelling, or itching. These reactions are typically mild and may resolve without treatment. Conjunctivitis (pink eye) and other eye-related issues may occur with some biologics and are usually mild and manageable with eye drops. Cold sores may occur more frequently in patients with a history of oral herpes. Upper respiratory tract infections may be slightly more common but are generally mild.
Rare Complications
Serious allergic reactions are rare but can occur. Signs include difficulty breathing, swelling of the face or throat, and severe rash. Eosinophilic conditions have been reported rarely and require medical evaluation. Some patients may develop antibodies to the medication, potentially reducing its effectiveness over time. Regular monitoring by your dermatologist helps identify and manage any complications early.
Your dermatologist can discuss strategies to minimise risks, including proper injection technique, hygiene measures, and prompt reporting of any unusual symptoms. The overall safety profile of eczema injections is generally well-tolerated by patients.
Cost Considerations
The cost of eczema injections in Singapore varies based on several factors including treatment duration, dosing requirements, and individual response to therapy. The medication represents an investment that patients should consider carefully. Costs typically include the medication itself, initial consultation and assessment, injection training sessions, and regular follow-up appointments.
Some patients may qualify for medication assistance programmes. The total treatment cost should be weighed against the potential reduction in other medications and healthcare visits. During your consultation, your dermatologist can provide a detailed breakdown of expected costs and discuss available options.
Individual treatment plans and associated costs vary based on medical assessment and patient needs.
Frequently Asked Questions
How quickly will I see results from eczema injections?
Individual responses vary significantly. Some patients may begin noticing changes in itching, with skin improvement potentially occurring over several weeks to months. Your dermatologist typically monitors your progress and may adjust your treatment plan if needed. Continue the treatment as prescribed, as stopping early may result in symptom return.
Can I stop my other eczema medications once I start injections?
Initially, continue your current eczema treatments unless specifically instructed otherwise by your dermatologist. As the injections begin to work, your dermatologist may gradually reduce other medications based on your response. Some patients may eventually reduce or minimise oral medications and topical steroid use. However, basic skincare with moisturisers typically continues as part of your maintenance routine.
Are eczema injections painful?
The injections cause minimal discomfort, often described as a quick pinch or sting lasting only a few seconds. Using an auto-injector device and allowing the medication to reach room temperature before injection can help minimise discomfort. Patients generally find the injections tolerable. Rotating injection sites and proper technique also help reduce any discomfort.
Can I administer the injections myself at home?
Yes, after proper training from your healthcare provider, patients can safely self-administer injections at home. The training covers proper injection technique, site rotation, storage requirements, and disposal of used materials. Some patients prefer the convenience of home administration, though others choose to have injections done at the clinic. Auto-injector devices make self-administration easier and safer.
What happens if I miss a dose?
If you miss a scheduled injection, contact your dermatologist’s office for guidance. Generally, you should take the missed dose as soon as possible, then resume your regular schedule. Don’t double up on doses to make up for a missed injection. Maintaining a consistent injection schedule is important for treatment effectiveness, so setting reminders can help you stay on track with your treatment plan.
Are eczema injections suitable for children?
Injectable biologics are approved for different age groups depending on the specific medication. Dupilumab is approved for patients as young as 6 months with moderate to severe atopic dermatitis, while lebrikizumab and nemolizumab are currently approved for adolescents aged 12 years and above. Your dermatologist can discuss whether injectable treatment is appropriate for your child based on their age, eczema severity, and previous treatment responses.
How long will I need to continue the injections?
Eczema injections are typically a long-term treatment, as atopic dermatitis is a chronic condition. Treatment duration varies by individual. Your dermatologist can regularly assess your response and may attempt dose spacing or discontinuation in some cases. However, symptoms may return when treatment is stopped, potentially necessitating resumption of therapy. The treatment duration is individualised based on your response and preferences.
Can I receive eczema injections if I have other medical conditions?
Patients with other medical conditions may be able to receive eczema injections, but a thorough medical evaluation is essential. Conditions like asthma may improve with treatment since they share similar inflammatory pathways. However, certain conditions may require special monitoring or preclude treatment. Your dermatologist typically reviews your complete medical history and coordinate with your other healthcare providers for safe treatment.
How do I know which biologic injection is right for me?
The choice of biologic depends on several factors including your age, eczema severity, predominant symptoms, previous treatment responses, and medical history. Your dermatologist can assess whether your eczema is characterised more by inflammatory skin changes or severe itching, review any comorbid conditions, and discuss your treatment preferences. Your dermatologist can recommend the most suitable option based on this comprehensive evaluation.
Conclusion
Eczema injections represent an advancement in treating moderate to severe atopic dermatitis, offering options for patients who have not responded adequately to conventional treatments. With multiple HSA-approved biologics now available in Singapore—including dupilumab, lebrikizumab, and nemolizumab—treatment can be tailored to target specific inflammatory pathways relevant to individual symptom profiles. By addressing distinct aspects of eczema inflammation and pruritus, these injectable biologics may provide symptom management with established safety profiles. While the treatment requires commitment, patients may experience improvements in their skin condition and overall quality of life.
If you’re managing eczema that hasn’t responded adequately to other treatments, consulting with a dermatologist can help determine if injectable therapy might be suitable for you.
Ready to Take the Next Step?
If you’re considering eczema injections, our Dermatologist can help you understand if it might be suitable for your needs. With experience in treating moderate to severe atopic dermatitis, we provide personalised care throughout your journey.
Dr Liew Hui Min
Dr. Liew Hui Min is an accredited consultant dermatologist from the Ministry of Health and the General Medical Council UK.
Her clinical interest includes:
- Paediatric Dermatology,
- Women’s Dermatology,
- General Adult Dermatology.
Having trained in major London Hospitals, Dr Liew returned to Singapore in 2014 as a Consultant at KK Women’s and Children’s Hospital (KKH) where she specialised in paediatric, women, obstetric and vulva dermatology. Currently, Dr Liew practices at The Skin Drs. clinic located at Gleneagles Hospital.
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