Noriko Cowles noticed early in her son’s life that he was having serious skin issues. “Jefferson started showing eczema flare-ups and rashes very early, right after he was born,” recalls Cowles, 49, of Long Beach, CA. While breastfeeding, she made changes to her diet to try to help him, such as switching from dairy to soymilk. Still, as Jefferson grew, his eczema continued to worsen, often requiring his mom to wrap his hands in bandage tape so he couldn’t scratch his rashes. She used gauze and band-aids to cover up the itchiest spots on his body.
Jefferson, now 10, was always an outgoing child, so it was tough for him to accept the restrictions he had to follow due to his condition. “We limited the animals he could touch at petting zoos, and we brought his own cupcakes to other children’s birthday parties,” Cowles remembers. “At one point, he was asked to leave a baseball event because they thought he had chickenpox, and his childcare center required us to get a doctor’s note to ensure his eczema was not contagious.” It was painful for her to see the way her son was treated by others, as well as the lack of information out there to educate the public about eczema.
After years of frustrating treatment attempts that didn’t fully cure his symptoms, Cowles enrolled Jefferson in a clinical trial of Dupixent in 2018. Dupixent is a biologic eczema drug that recently received FDA approval for use in children ages 6 to 11 with moderate to severe atopic dermatitis. Three-quarters of children in Dupixent trials saw at least a 75% improvement in their overall disease, with an average symptom improvement of approximately 80%.
For parents like Cowles, this is a big deal! “We don’t see flare-ups that we used to see when he was a baby and a toddler anymore,” she says. “We don’t see those rashes on his face, and no one is asking us if he has chickenpox.” While Jefferson still gets redness on hot, dry days, or when he comes in contact with shedding animals, Cowles is now easily able to manage his flares with anti-itch cream. It has been a major change in her family’s life and her peace of mind as a mom.
Kids & Eczema
Atopic dermatitis is a type of eczema that usually shows up within the first few months or years of a child’s life. It’s caused by a reaction in the immune system in response to irritants or allergens–the exact trigger can differ from person to person and is very difficult to pinpoint. Symptoms common in children include scaly skin, redness, cracking skin, itchiness, and rashes on the arms, cheeks, or legs. “We make the diagnosis by having a rash of a particular appearance, often in certain areas that may be somewhat age-dependent,” explains Amy Paller, M.D., professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago.
Most children have mild to moderate eczema, which can often be managed with topical steroid creams. Data from the Journal of Dermatitis estimates that two-thirds of U.S. children with eczema have a mild version of the disease, while the remaining one-third have moderate to severe symptoms.
Topical medications are an early line of defense against eczema symptoms, along with dietary adjustments and close attention paid to potential external irritants, like fabrics or chemicals. “We begin with the basics: we want to avoid any triggers, such as known allergens, irritants, and environmental extremes that can cause a flare,” says Peter Lio, M.D., board member for the National Eczema Association and clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago.
From there, a dermatologist will work to strengthen the skin barrier with moisturizers, gentle cleansers, and if needed, topical creams. Often, these treatments provide the relief a child needs to live a normal life. But in some cases, it still isn’t enough. “For these patients, the suffering is great, and many times they have seen multiple doctors seeking answers and relief,” Dr. Lio says.
This was the case for Cowles and Jefferson. While Cowles initially thought her son had a food allergy, she still wasn’t able to stop his itching with dietary changes and use of organic allergen-friendly fabrics. “Still, he got flare-ups and rashes on and off, so we took him to a food allergy specialist and dermatologist, on top of his primary care physician,” she says. “They prescribed cream that contained steroids and antibiotics, but it was a temporary solution.”
How Dupixent Can Help
Dupixent is a prescription medication, taken as a skin injection, that is meant for use in people with eczema that cannot be controlled with topical therapies. It was first approved for adults in 2017, followed by approval for teenagers in 2019. In May 2020, the FDA officially gave the green light for Dupixent to be prescribed to children ages 6 to 11. It comes in two doses, prescribed based on the child’s weight, and is administered either every two or every four weeks. It is recommended that people keep taking Dupixent shots for the skin to remain clear.
Dr. Paller helped lead the Dupixent clinical trials, and she recalls seeing the way the children’s symptoms quickly changed after starting treatment. “Suddenly these children have a life again, and these families have a life again too,” she says. “Many children have clearance or near clearance with this medicine in a way they’ve never been able to achieve.” In the future, she and her team plan to study even younger children, in the hopes that they can modify the course of eczema even earlier in the disease’s initial progression.
It's important to note that Dupixent won’t be a miracle solution for everyone. Side effects can include injection site reactions, eye inflammation, cold sores on the mouth, and less commonly, a more severe allergic reaction. Not every child in the clinical trials achieved substantial symptom relief. “There are some people for whom [Dupixent] doesn’t make enough of a difference, and we have to think of other options,” Dr. Paller notes. “But it’s really made more of a difference than anything else that’s been out.” Dr. Lio agrees. “While this certainly does not ‘cure’ eczema, nor does it work for everyone, the powerful efficacy paired with a much better safety profile than the immunosuppressants makes it a very important therapeutic option,” he says.
The reality is that atopic dermatitis can be a time-consuming condition for both children and parents. “The investment of time, the investment of resources, and potentially the impact on others in the family is very much affected by having a child with moderate to severe eczema,” Dr. Paller says.
In Cowles’ case, starting Jefferson on Dupixent opened up his life in a way he hadn’t previously experienced. “He always tried to enjoy activities with his brother, his parents, his grandparents, and his friends,” she notes. “But now with Dupixent, he can keep playing baseball, he can show his skin without hiding in long sleeves, he can go swimming, and the list goes on. He can even now dream about being a dog owner!”