What biological creams are available for skin conditions like psoriasis, eczema, and acne?

Biological Creams Available for Skin Conditions

Currently, there are no true biological creams available on the market for skin conditions like psoriasis, eczema, or acne. Biological therapies for skin conditions are primarily administered as injections or infusions, not as topical creams.

Available Biological Therapies for Skin Conditions

For Psoriasis:

• First-line biologic agents for adults with psoriasis are administered as injections or infusions, not as creams, and include:

  • Ustekinumab - recommended as a first-line biologic agent for adults with psoriasis 1
  • Adalimumab - recommended particularly when psoriatic arthropathy is a consideration 1
  • Secukinumab - recommended for adults with psoriasis, with or without psoriatic arthritis 1

• For children with psoriasis, approved biologics include:

  • Adalimumab (age ≥ 4 years)
  • Etanercept (≥ 6 years)
  • Ustekinumab (≥ 12 years) 1

• Infliximab should be reserved for very severe disease or when other biologics have failed 1, 2

Topical Options (Non-Biological):

• For psoriasis, eczema, and other inflammatory skin conditions, topical calcineurin inhibitors like pimecrolimus (Elidel) are available, but these are not considered biological therapies 3
• Pimecrolimus cream is indicated for atopic dermatitis (eczema) but should be used only after other prescription medicines have not worked 3

Why Biological Therapies Are Not Available as Creams

• Biological agents are typically large protein molecules (antibodies or fusion proteins) that cannot effectively penetrate the skin barrier when applied topically 4, 5
• These molecules target specific cytokines like TNF-α, IL-17, IL-23, or IL-12/23 that play roles in the pathogenesis of psoriasis 4, 6
• Due to their molecular size and structure, biologics require systemic administration (injection or infusion) to reach their targets 5

Administration Routes for Biologics

• Current biological therapies for skin conditions are administered as:
  • Subcutaneous injections (e.g., adalimumab, etanercept, ustekinumab, secukinumab) 1
  • Intravenous infusions (e.g., infliximab) 1

Important Considerations

• Biological therapies should only be initiated and supervised by specialist physicians experienced in diagnosing and treating psoriasis 1
• These treatments are typically reserved for moderate-to-severe cases that have failed conventional therapies 1
• Regular monitoring is required during biological therapy to assess response and potential adverse effects 1
• For pediatric patients, options are more limited, but some biologics have been approved for children with severe psoriasis 1, 7

Common Pitfalls and Caveats

• Misunderstanding that "biological" creams exist for these conditions when they do not
• Using topical calcineurin inhibitors (like pimecrolimus) inappropriately:
  • Should not be used on malignant or pre-malignant skin conditions 3
  • Should not be used in patients with Netherton's Syndrome 3
  • Should not be used continuously for long periods 3
  • Should not be used in children under 2 years of age 3
• Failing to recognize when a skin condition requires systemic therapy rather than topical treatment 1
• Not considering the presence of psoriatic arthritis when selecting therapy 2