When It Comes to Interleukins and Atopic Dermatitis,13 Is a Lucky Number |Fall Clinical Derm 2025

There are some 40 interleukins that play a wide variety of roles in inflammation and the body’s immune response, some of them hitting the accelerator and others tapping the brakes. When it comes to atopic dermatitis (AD), interleukin-13 (IL-13) seems to be the most important one.

“AD is being increasingly recognized as an IL-13 dominant disease,” Mona Shahriari, M.D., said in an interview conducted at the 2025 Fall Clinical Dermatology Conference this weekend in Las Vegas. “Not only does IL-13 do a lot, but targeting IL-13 and that direct inhibition can actually help a lot of our patients with the signs and symptoms of ADAD that they're suffering with,” Shahriari added.

Shahriari is a dermatologist at Central Connecticut Dermatology in the Hartford, Connecticut, area and an associate clinical professor at the Yale School of Medicine in New Haven, Connecticut. She was one of the panelists at a session at the meeting on IL-13 for the management of atopic dermatitis.

Atopic dermatitis, the most common form of eczema, is caused by dysregulated activation of type 2 T helper cells and type 2 innate lymphoid cells that is associated with elevated levels of IL-13 and other pro-inflammatory cytokines, notably interleukin-4 (IL-4). Shahriari noted that IL-13 can be present both in lesional and nonlesional skin and that it contributes to both the chronicity and severity of atopic dermatitis and to the symptom of itch that is a frequent symptom of atopic dermatitis.

Shahriari discussed the three FDA-approved biologics that are approved as treatments for atopic dermatitis: dupilumab (sold under the brand name Dupixent), tralokinumab (sold under the brand name Adbry), and lebrikizumab (sold under the brand name Ebglyss). She noted that dupilumab works by the IL-4 receptor alpha, which has the effect of inhibiting IL-13 signaling. Tralokinumab and lebrikizumab both target IL-13 specifically. Lebrikizumab latches on to the cytokine “more intensely, with a higher affinity” than tralokinumab, she said.

Shahriari said she and her fellow panelists discussed some specific cases during their session on IL-13 inhibitors to tease out some of the choices involved when using the biologics. She mentioned an adolescent who had dermatitis on his head and neck. He wanted an agent that he didn’t need to inject frequently, so he was treated with lebrikizumab, which has a monthly dosing schedule, she said. There was also concern about flare-ups of atopic dermatitis with dupilumab, she said. “This [lebrikizumab] was a great option for him and he responded well,” said Shahriari.

Although atopic dermatitis that covers large areas of body — dermatologists use the term body surface area (BSA) — is often considered more serious, Shahriari said cases that affect “high impact” parts of the body, such as the face and hands, can be troubling for patients. There are data showing that the IL-13 inhibitors work quite well for patients with high-impact disease, she said.

Shahriari also discussed switching patients from one IL-13 inhibitor to another or from an IL-13 inhibitor to a Janus kinase inhibitor, a class that includes Rinvoq (upadacitinib), an oral drug, and Opzelura (ruxolitinib), a cream. She mentioned the ADapt trial, a study that assessed the safety and efficacy of lebrikizumab in adults and adolescents with moderate-to-severe AD who had previously been treated with dupilumab. Patients must have discontinued dupilumab due to inadequate response, intolerance, or an adverse event. Results reported in the journal Skin in January 2025 showed improvement in skin clearance, itching and quality of life after 16 and 24 weeks of treatment with lebrikizumab among veterans of treatment with dupilumab.

“There’s a lot that IL-13 inhibition can offer our patients,” Shahriari said.