People with moderate to severe eczema often try many treatments before finding one that works for them. If strategies such as applying topical corticosteroids don’t help or can’t be used, injections of biologic drugs might relieve eczema symptoms for children and adults.

The U.S. Food and Drug Administration (FDA) has approved two biologic drugs to treat moderate to severe atopic dermatitis — the most common form of eczema — that hasn’t responded to or can’t be treated with topicals. Dupilumab (Dupixent) is approved to treat people ages 6 months and up, and tralokinumab-ldrm (Adbry) is approved to treat adults.

Both dupilumab and tralokinumab-ldrm are monoclonal antibodies, which are human-made proteins that work by interfering with the immune system. Both drugs are given as subcutaneous (under the skin) injections, either by a health care worker or by self-injection.

People thinking about trying injectable treatments may have concerns, especially about the method — an estimated 2 in 3 children and 1 in 4 adults have a fear of needles. This article will review four types of details to know about when giving yourself injections for eczema.

1. Safety Precautions and Side Effects

As with any medical treatment, it’s important to understand the safety precautions and possible side effects before starting injections for eczema. Dupilumab and tralokinumab-ldrm involve similar safety considerations.

Common Side Effects

One of the most common side effects of dupilumab and tralokinumab-ldrm is an injection site reaction, characterized by swelling, discoloration, itching, and pain. Usually, these reactions around the injection site become less frequent and less severe as people continue treatment.

Another possible side effect of both drugs is the onset or worsening of certain eye conditions, including conjunctivitis (pink eye) and keratitis (inflammation of the outer layer of the eye). Symptoms include redness, itching, and irritation of the eye, eyelid, or lining of the eye.

Eosinophilia, an increased amount of white blood cells called eosinophils, is also a common side effect of these two drugs. Symptoms include cough or difficulty breathing, bruising or rash, fever, and chest pain, as well as burning, numbness, or tingling in the hands.

In addition to these shared side effects, dupilumab commonly causes cold sores.

Allergic Reactions

Although rare, severe allergic reactions can occur with both medications. People using dupilumab or tralokinumab-ldrm should be aware of symptoms of a life-threatening allergic reaction, including:

• Fever
• Joint pain or swelling
• Hives
• Facial, mouth, hand, or foot swelling
• Light-headedness or fainting
• Dizziness
• Muscle aches
• Trouble breathing or swallowing
• Swollen lymph nodes

If any of these symptoms develop following an injection, tell your health care provider immediately. Being prepared for potential side effects and knowing how to respond can help relieve unwanted confusion and stress if they do occur.

Interactions With Other Drugs

Eczema injections can also interact with other drugs — specifically, live vaccines. Live vaccines contain a weakened version of a disease-causing germ and have the potential to cause disease in people with weakened immune systems. Because eczema injections affect how the immune system works, people taking them can’t get live vaccines.

2. Steps for a Safe Self-Injection

Knowing the steps for self-injection is crucial for safe use. Importantly, steps vary slightly based on whether you’re using a syringe or a pen. Dupilumab is available in both pre-filled forms, while tralokinumab-ldrm is available only as a pre-filled syringe. The manufacturers of dupilumab recommend the following steps for a pre-filled syringe self-injection:

1. Make sure that the syringes are the correct medication and dose and that they haven’t expired.
2. Remove a syringe from its carton, holding the middle of the syringe body. Don’t take off the needle cap yet.
3. Make sure you have all required supplies, including the syringe, a cotton ball or piece of gauze, an alcohol wipe, and a container for needle disposal.
4. Inspect the medication through the syringe viewing window to ensure that the liquid inside looks clear and colorless to pale yellow.
5. Place the syringe on a flat surface and let it naturally warm to room temperature. Don’t apply any heat.
6. Choose an injection site on the thigh or belly (except for 2 inches around the bellybutton) if self-injecting, avoiding damaged or tender skin. If you’re a caregiver injecting the medication, you may inject it into the person’s outer upper arm.
7. Wash your hands, clean the injection site with the alcohol wipe, and let the skin dry.
8. Hold the syringe in the middle, with the needle pointing away, and remove the cap without touching the needle.
9. Pinch a fold of skin at the injection site, and insert the needle completely at about a 45-degree angle.
10. Relax your pinch and push the plunger rod down slowly as far as possible, until the syringe is empty. Release the plunger until the needle shield covers the needle, and then remove the syringe from the injection site.
11. Gently apply the cotton ball or gauze to any bleeding, and avoid rubbing the skin.
12. Place the used syringe and needle cap in an FDA-cleared needle disposal container right away.

Using a dupilumab pre-filled pen follows a similar procedure but has a few differences. Review the manufacturer’s instructions before doing an injection.

3. Strategies To Minimize Injection Site Pain

Injection site pain is a common issue reported with eczema injections. Thankfully, effective strategies — several of which are incorporated into the manufacturer’s instructions — can minimize pain. For example, carefully choose an injection site, as some areas on the body are less likely to hurt.

Some members of MyEczemaTeam have tried this strategy. One member shared, “I am coming up on my fourth injection in my stomach, and I will do it myself this time. There was zero pain — the pen needle is so tiny you can’t feel it.”

Another member said, “Thanks for the advice on stomach injection. I was doing thigh and it killed. Absolutely zero pain in the stomach.”

Research supports these statements — studies show that people report more pain when using the thigh for injections as compared with the belly. With this pattern in mind, people at risk of injection site pain should use their belly for eczema injections. Alternating between injection sites may also reduce skin irritation and pain.

In addition, allowing the syringe to come to room temperature helps avoid pain associated with injecting a cold liquid. Applying pain-reducing lotions, creams, or ointments and icing the site before self-injection can also help reduce pain.

Injection site pain prevention actually starts before the first dose is given, with carefully learning and practicing injection techniques. Try to review the instructions in person with a trained health care professional, like a physician or nurse. They can demonstrate the correct injection technique, explain the risk of injection site pain, answer your questions, and address your concerns.

4. Ways To Reduce Needle Anxiety

Self-injection offers a convenient alternative to traveling to a doctor’s office to receive the medication, and you can give yourself the treatment on your preferred schedule. However, needle anxiety or phobia can make self-injection feel intimidating.

Minimizing needle anxiety is important for promoting emotional well-being, preventing injection site pain, and encouraging people to continue with effective treatment plans. You can help ease needle anxiety by:

• Learning more about the procedure and how it will help
• Understanding what’s causing the fear and addressing causes that are within your control
• Managing injection site pain, which can reduce panic and fear
• Practicing relaxation techniques such as breathing exercises

If you or someone you love is living with eczema and needle phobia but wants to try eczema injections, talk with your dermatologist about incorporating these strategies. They can also help tailor your plan to best address your fears and needs, helping you to better manage your eczema symptoms and improve your quality of life.

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Have you tried injections for eczema? What do you wish you had known about injections when you first started them? Share your experiences and thoughts in the comments below or by posting on your Activities page.