By Jennifer L. Shastry, MD, with Keri Wiginton
Shastry is an assistant professor of dermatology at Northwestern Feinberg School of Medicine in Chicago. The information here represents her knowledge and experience as a medical professional. She was not involved in the development of or clinical trials for nemolizumab (Nemluvio).
Atopic dermatitis (AD) is the most common form of eczema. It causes itchy, inflamed skin that can show up anywhere on the body, though it likes to settle in skin folds like the elbows and behind the knees. AD is a long-term condition that comes and goes, and it can affect people of all ages.
Your rash might look different from someone else’s, depending on your skin tone. You might have pinkish patches, darker, thickened areas, or small bumps. But the itch is often the worst part. It can keep you up at night, make daily life hard, and even lead to skin infections.
If you can’t stop scratching, a new treatment might help.
The FDA approved nemolizumab (Nemluvio) for moderate-to-severe atopic dermatitis in December 2024. To explain how this medication works and who might benefit from it, we spoke with Jennifer Shastry, MD, a dermatologist with Northwestern Medicine in Chicago.
Who is nemolizumab for?
This treatment is for people 12 and older who have moderate-to-severe atopic dermatitis that hasn’t gotten better with topical treatments, which are medications like steroids and calcineurin inhibitors that you rub on your skin.
It’s worth considering if your itch keeps you up at night, makes it hard to focus at work or school, or just won’t go away no matter what you try.
How do I know if my condition is bad enough for this treatment?
Talk to your dermatologist. They’ll check your skin and ask about your symptoms. Doctors use a scoring system to rate how serious eczema is.
But here’s a simple way to think about it: If your itch makes your life miserable, it’s time to talk about stronger treatment options.
What’s different about this drug?
Nemolizumab is a monoclonal antibody, a type of medication that targets specific parts of the immune system. Other biologics for atopic dermatitis block proteins that broadly control inflammation and itch. But this one blocks IL-31, a key signal that triggers itching.
Most other treatments, like steroid creams, focus on calming the rash. Nemolizumab goes straight to the source of the itch to help break the itch-scratch cycle, giving your skin a chance to heal.
Does stopping the itch really help the skin heal?
Absolutely. Scratching damages your skin’s protective barrier, making it easier for allergens and germs to get in. That leads to more inflammation, more itching, and more flares.
Breaking this cycle can be a game-changer. When your skin gets a chance to recover, it’s less likely to crack, sting, or get infected.
Can you still use other atopic dermatitis treatments?
Yes, and you should. This treatment works best alongside topical treatments like steroids and nonsteroidal creams, such as calcineurin inhibitors.
In clinical trials, people continued using their usual topical treatments. But as their skin improved, many needed them less over time.
Can nemolizumab help you use fewer steroids?
That’s the goal. Long-term steroid use can thin your skin, so cutting back is a big plus. As your skin heals and flares become less frequent, you may not need steroid creams as often.
How effective is this treatment? How fast does it work?
In clinical trials, 38% of people taking nemolizumab had clear or almost clear skin by week 16, which is pretty fast improvement. By week 48 (almost a year later) around 64% had clear or almost clear skin whether they were getting the treatment every four weeks or every eight weeks.
These results show that it works quickly and continues to improve over time.
How do you take nemolizumab?
It’s a shot you give yourself. Most people find the prefilled self-injector pen easy to use.
The first dose is two shots (60 millirams total), known as a loading dose. After that, you take one shot (30 milligrams) every four weeks. If your skin improves after 16 weeks, you might be able to switch to a single shot every eight weeks.
You can give yourself the shot at home, but most people start with a training session at their doctor’s office. A nurse will show you how to do it. Usually, they’ll give you one shot, and you’ll do the other. If you’re comfortable with it, you can then have the medication shipped to your home for you to do.
Is nemolizumab safe?
Yes, otherwise the FDA wouldn’t have approved it for the general public.
Side effects were minimal in studies. The most common were things like headache and muscle or joint pain. Like with any injection, you might get some redness, swelling, or mild itching where the shot goes into your skin, but that usually goes away in a few days.
Serious allergic reactions, like swelling in the face or lips, were very rare. But if that happens, you should get medical help right away. This is one reason why you get the first shot at your doctor’s office.
Could this medication make atopic dermatitis worse?
Nemolizumab should reduce itch and other eczema symptoms, but some people with AD experienced a flare during treatment. If your symptoms get worse after you start it, check in with your doctor. They might do a skin biopsy to confirm you have atopic dermatitis and not something else.
How long do you need to take it?
Atopic dermatitis is chronic, meaning it won’t go away for good. While you may not need this treatment forever, expect to take it for several years to keep your symptoms under control.
Does it increase my risk of getting infections?
Unlike some other biologics, nemolizumab doesn’t seem to weaken the immune system in a way that makes it more likely that you’ll get things like upper respiratory infections. Some people in trials said they experienced mild colds or stuffy nose, but that’s not something we’re very concerned about.
There was a small increase in shingles cases in the trials, so that’s something to watch for. You should also avoid live vaccines while taking it.
How often do I need to see my doctor?
You’ll likely need to check in two to three months after starting. At four months, your doctor will help decide whether you can switch to every eight-week dosing. If things are going well, you may only need checkups every four to six months.
Will your insurance cover it?
It depends. Many insurance plans require you to “try and fail” topical treatments first. Some may want you to try another systemic treatment (like pills or an older biologic) before approving nemolizumab. Check with your insurance company to see what’s covered.
How do I know if this medication is right for me?
If your itching is out of control – keeping you up at night, making it hard to focus, or just making you miserable – this could be a great option. If you rate your itch as a 4 or higher on a 10-point scale most days, it’s time to talk with your dermatologist about next steps.
How carefully was this drug studied?
Researchers tested nemolizumab in two large clinical trials (ARCADIA trials) with over 1,100 people. These were randomized and controlled studies, meaning some people got the drug and others got a placebo (a lookalike treatment with no active drug) for comparison.
They tracked people for up to 48 weeks. The results were solid – people saw real improvement in their skin, and side effects were manageable. Longer-term studies are still ongoing, but the data so far is promising.
Another interesting detail is that unlike some other treatments, the dosing doesn’t change based on body weight, and it was shown to work similarly well across different age groups, including teenagers.
What does this approval mean for atopic dermatitis treatment?
This is a hopeful time for atopic dermatitis treatment. In the past few years, we’ve seen more treatment options become available, which has been life-changing for many people.
Nemolizumab is especially exciting because it focuses on itch, which is a symptom that many of my patients say is even worse than pain.
Have you seen people improve with this treatment?
Yes! Even though it was just approved, I’ve already seen people with severe, uncontrolled itching improve on nemolizumab after not getting enough relief from other medications.
Some have had a major reduction in itch in a short amount of time. We’re not at the 16-week mark for many patients yet, but the early responses have been really promising. Seeing people finally get relief from something that’s been such a daily struggle is encouraging.
