Atopic eczema/dermatitis, a chronic relapsing skin condition characterized by skin rashes, inflammation and itching, affects around 101.27 million (10%) adults and 102.78 million (20%) children worldwide. You or someone you love may suffer with eczema and be faced with the decision about which treatment options to try.
This article compares and contrasts the biologic drug dupilumab/Dupixent and Chinese herbal medicine (CHM) to help people who are trying to decide which route to take in managing their eczema. My clinical practice of over 20 years is mainly focused on dermatology, allergic, chronic inflammatory and mystery diseases and my graduate degree is in Chinese Medicine. Providers of CHM medicine and biomedicine alike can be biased toward the medicine in which they’ve trained and practiced so it can be difficult to find balanced comparison information to consider as you make a choice so I’ve tried my best to present this information to you in a fair and balanced way. This article was extensively researched, worked on over a span of six weeks, has undergone at least six major revisions, and I received feedback from the professional writing mastermind group that I belong to. A reference list is located at the end of the article. I really hope that readers find this comparison analysis helpful while considering how to manage their eczema care plan.
Comparison of Dupilumab/Dupixent to Chinese Herbal Medicine
Dupilumab/Dupixent
Dupilumab, a prescription biologic medication recently approved by the FDA, is also known under the brand name Dupixent. Biologic drugs are specialized medicines produced within living cells, aimed at targeting certain parts of the immune system associated with a specific disease. Unlike oral or topical medications, they are metabolized differently by the body. Dupilumab is one such biologic, classified as a monoclonal antibody. Dupixent is self-administered as an injection every couple of weeks.
To qualify for dupilumab, you usually need to have tried at least one immunosuppressive medication, like azathioprine, ciclosporin, or methotrexate and found that it didn't help you or if you couldn't tolerate those medications. This process can take months before qualifying for approval.
Treatment Duration and Method of Administration of Dupilumab/Dupixent
Dupilumab is intended for long-term use, administered as a bi-weekly injection under the skin indefinitely or until discontinued. You are trained how to self-administer the shot at home to yourself or your child. Upon cessation, eczema typically recurs rapidly. Its use helps to manage symptoms but does not result in remission after therapy is discontinued. If your skin is unresponsive after four months (16 weeks) the treatment is discontinued. It is approved for individuals aged 6 months and older.
Chinese Herbal Medicine
Chinese herbal medicine (CHM), also known as traditional Chinese medicine, is rooted in centuries of practice, takes a holistic view by considering the interconnectedness of the body, mind, and environment. CHM are mainly plant medicines, but may also include mineral, animal or marine life products. They are typically taken orally twice per day.
Throughout its extensive history, TCM has been widely utilized to manage atopic dermatitis, restore the skin barrier, prevent disease recurrence, sustain long-term remission, and alleviate the burden of the condition. Unlike dupilumab, you can start Chinese herbs immediately.
Chinese medicine is not a one size fits all approach. Herbal formulations are tailored to each person’s unique eczema presentation and overall health, addressing not only symptoms but also underlying root causes. Chinese herbal medicine addresses eczema as a manifestation of root internal imbalances such as excess interior heat and/or dampness which lead to inflammation and itch, as well as susceptibility to outside factors such as dry, damp, cold, hot or humid weather, exposure to pollutants and chemicals. This distinctive approach often leads to disease remission rather than solely diminishing symptoms.
Herbal formulas are typically carefully composed of approximately three to fifteen herbs which work synergistically to address the disease pattern. As the disease presentation shifts, the herbs within the formula will change or an entirely new herbal formula will be used. The beauty of Chinese medicine is that the herbal formulas can be changed anytime in response to changes or plateaus during the duration of treatment. So as the skin changes and heals your practitioner changes the ingredients in your herbal formulas in phased treatment.
Treatment Duration and Method of Administration of Chinese Herbal Medicines
CHM is typically taken orally for six months to one year, twice daily, until eczema reaches remission or significantly resolves and becomes much easier to manage. They can be taken as a tea, a liquid concentrate, granules, tablets, or capsules.
After the initial six months to one year, if flare-ups occur, they usually aren’t difficult to control if you and the CHM herbalist act quickly. There is a subset of people who need to take herbs on an ongoing basis to manage eczema. If your skin does not respond to CHM after four or five months (16-20 weeks) the treatment is usually discontinued and/or some CHM practitioners will refer out to an herbal dermatology specialist such as myself.
Chinese medicine also combines the oral route with topical skin care infused with herbs. For infants, herb washes, baths, and creams or ointments are common, while toddlers, children, teens and adults use internal oral administration methods such as teas, liquids, granules, or capsules, alongside external applications like washes, creams, or ointments.
I am dedicated to teaching my clients topical skin care, bathing, lifestyle and dietary recommendations for long-term management. Before consulting with me, most people were never taught long term skin care techniques by a dermatologist or other care provider including nurse practitioners, naturopaths, other CHM practitioners, functional medicine doctors etc. Without learning how to protect and nourish your skin, you are left more vulnerable to flare-ups and infections.
Quick Comparison Chart
Dupilumab/Dupixent | Chinese Herbal Medicine | |
|---|---|---|
Treatment Duration | Long-term | Usually 6 months to 1 year, until remission, then as needed shorter term |
Method of Administration | Injection under the skin, self administered every two weeks at home | Orally, twice daily self administered at home until remission |
Time It Takes To Start Working | Dupilumab may show relatively quick results, with improvements observed within a few weeks of treatment initiation, many patients are clear or near clear in 4 months | Chinese herbal medicine, while requiring a more gradual approach, offers sustained benefits with results typically seen over several weeks to months many people are clear or near clear in 4-8 months |
Treatment Discontinuation & Long Term Benefits | One drawback of dupilumab is the potential for relapse upon treatment cessation. | Chinese herbal medicine aims to balance the root, potentially reducing the likelihood of relapse when treatment is discontinued and leading to long term remission |
The Science Behind Dupilumab/Dupixent and Chinese Herbal Medicine for Eczema
Science Behind Dupilumab/Dupixent
The mechanism of action of dupilumab is that it blocks the actions of two specific proteins called interleukins to alleviate symptoms of eczema. Those proteins are interleukin-4 (IL-4) and interleukin-13 (IL-13). IL-4 starts the immune response by telling the body to make special antibodies and activating cells that cause inflammation. Then, IL-13 steps in, causing more inflammation, itchiness, and damage to the skin's barrier. People with eczema have an immune system that reacts strongly to triggers like food allergens, dust, mold, and pollen, pet dander, chemicals on clothing, metals in jewelry, belts, buttons thus producing too much IL-13.
Science Behind Chinese Herbal Medicine
Research studies show that many Chinese herbal medicines are effective for reduction of inflammation, itch relief and are antimicrobial. Many Chinese herbs are effective agents against the pathogens that adhere to gut biofilms which may contribute to skin and digestive disorders. A 2016 study explains the science behind reduced inflammation and itch from active constituents of some herbs, “Gallic acid and chlorogenic acid could suppress the release of pro-inflammatory cytokine IL-6 and chemokine CCL7 and CXCL8, respectively, in IL-31- and IL-33-treated eosinophils-dermal fibroblasts co-culture; while berberine could suppress the release of IL-6, CXCL8, CCL2 and CCL7 in the eosinophil culture and eosinophils-dermal fibroblasts co-culture (all p < 0.05)”.
Another CHM study showed, “Bioactive ingredients of TCMs for AD [atopic dermatitis] decrease plasma total IgE and histamine, probably by suppressing mast cell degranulation and the PERK pathway, which most inhibit eosinophil accumulation and pro-inflammatory cytokine expression in damaged skin tissues. Some TCM constituents, e.g., capsiate, have anti-proliferative and anti-differential effects on CD4 + T cells, which can further lead to inhibition of Th1-, Th2-, Th17-mediated cell differentiation. In addition, the effects of TCM constituents on decreasing the levels as well as expression of cytokines such as TNF-α, INF-γ, IL-4, IL-5, IL-6, IL-13, IL-33 and IL-1α, chemokines such as CCL2, CCL7, CCL8, TARC/CCL17 and MDC/CCL22, and pro-inflammatory factors such as RANTES, VCAM-1 and ICAM-1 in skin lesions treated with TCMs, have been most studied. The blockade of the MAPK/NF-κB pathway in keratinocytes can decrease ERK, JNK, p38 and NF-κB activation. Some researchers have focused on determining which mechanisms correct the Th1/Th2 imbalance skewed toward Th2. Ultimately, their findings may lead to the use of TCMs to attenuate skin pruritus and irritation, restore the skin barrier, and thereby improve AD patients’ quality of life.”
For those of you who are interested in reading more research, there is a bevy of research on the efficacy of individual Chinese herbs and herbal formulas for atopic eczema.
Safety and Side Effects of Dupilumab and Chinese Herbs
Dupilumab Safety and Side Effects
Possible side effects of Dupilumab/Dupixent include allergic reactions, head and neck dermatitis, eye problems, inflammation of blood vessels, joint aches and pains, as well as common side effects such as injection site reactions, upper respiratory tract infections, and eye and eyelid inflammation. Other common side effects may include dry eye, herpes virus infections, cold symptoms, cold sores, high white blood cell count, dizziness, muscle pain, diarrhea, throat pain, gastritis, joint pain, trouble sleeping, toothache, and parasitic infections. Additional reported side effects include facial rash, redness or psoriasis. If you experience any side effects, inform your prescribing healthcare provider. This list does not cover all possible side effects of dupilumab. Consult your doctor for medical advice.
Chinese Herbal Medicine Safety and Side Effects
Most people do not experience side effects from Chinese herbs. If people experience side effects the more common include digestive discomfort, bloating, gas, nausea, loose stools or diarrhea, allergic reactions, rashes, dizziness and increased liver enzymes. These side effects are also easy to manage, usually subsiding on their own within days to a week or after cessation. In extremely rare instances an anaphylactic allergic reaction is possible. If you have known allergies to any herbs, foods or substances be sure to inform your practitioner.
Just like Dupilumab/Dupixent, if you experience any herbal side effects that bother you or persist, inform your herbalist healthcare provider. Herbal formulas can be reformulated to mitigate side effects that you may have experienced. When prescribed by a qualified practitioner, herbs typically present fewer side effects. The emphasis on personalized formulations minimizes adverse reactions.
The Chinese herbs that I use in my clinical practice are third party lab tested, cGMP certified and source traceable. Extensive testing is conducted on herbs to verify their identity, check for adulteration, assess single and multiple compound compositions, determine solubility, bacterial contamination, measure levels of heavy metals, aflatoxin, sulfur compounds, and evaluate pesticide residues. TianJiang Pharmaceutical is world renowned for its commitment to these standards, botanical research and one of the main sources that I use for full spectrum, granule herbs. Additionally, I am partnered with the only FDA registered herbal pharmacy, Kamwo, to prepare pre-cooked, vacuum packed teas for my clients. For most of my granule compounding needs, I order from China Herb Co. in Philadelphia who stock granule herbs from TianJiang Pharmacy.
Cost Comparison Between Dupilumab/Dupixent and Chinese Herbs
Dupilumab can be expensive, with costs varying based on insurance coverage and healthcare systems. Chinese herbal medicine may offer a more cost-effective alternative, particularly in the long run because it addresses the underlying causes and promotes overall health. And in many cases once you finish the course of treatment of herbs, eczema usually goes into remission for extended periods of time whereas, if you stop Dupilumab the symptoms tend to reappear quickly.
Average Cost Breakdown in USA | Average Annual Cost | Average Additional Cost | Total Average Yearly Cost |
|---|---|---|---|
Dupilumab /Dupixent | $59,000 | Office Visits $200 | Approximately $60,000 per year |
Chinese Herbal Medicine | $6000 | Office visits $180 | Approximately $9,000 per year |
Your health insurance might cover dermatology office visits and the cost of the medication dupilumab. Many health insurance plans have prerequisites, such as failing other drugs first, that you'll need to meet before they approve the medication, and/or limits to how long they will cover the medication. Some health insurance plans cover office visits with a licensed practitioner of Chinese medicine. Health insurance will not cover cost of herbs. You can pay for office visits with a Flexible Spending Account (FSA) or Health Spending Account (HSA) and they usually allow you to pay for herbal supplements with these accounts. Occasionally they ask for a letter of medical necessity from the provider which is easy to obtain by request.
Additional Considerations and Experiences
Pregnant and lactating people should only use dupilumab under direct supervision of an MD, or not at all.
Pregnant and lactating people should only use Chinese herbs under direct supervision of a licensed herbalist with at least a Master's Degree in Chinese medicine.
Some people I’ve consulted with decided to add Chinese herbs to their care plan simultaneously and achieved better results and sought out my practice.
Some people I’ve consulted with experienced side-effects of dupilumab and needed to stop the drug, so they sought out my CHM practice.
Some people I’ve consulted with who had extremely severe weeping discoid/nummular eczema that I wasn’t able to resolve with CHM so I’ve referred them to their dermatologist to discuss using dupilumab.
Some people I’ve consulted with want to stop using dupilumab because they don't want to stay on a drug long-term, but are worried that their eczema will come back after they stop the drug, so they start CHMs while weaning off of the drug then continue on with the herbal care plan.
My Professional Opinion:
While dupilumab has shown efficacy in managing eczema symptoms and may be more likely to be covered by health insurance, Chinese herbal medicine stands out for its holistic approach, personalized treatments, low side effect profile, relative out-of-pocket affordability, and potential for long-term remission. The emphasis on balancing the body's internal environment distinguishes Chinese herbal medicine as a comprehensive and sustainable option for those seeking alternatives to conventional pharmaceuticals and positions it as a compelling choice for people navigating the challenges of eczema.
References
Akhtar NH, Khosravi-Hafshejani T, Akhtar D, et al. The use of dupilumab in severe atopic dermatitis during pregnancy: a case report. Allergy Asthma Clin Immunol. 2022;18:9. doi:10.1186/s13223-022-00650-w
Dupilumab (Dupixent®). Mother To Baby | Fact Sheets. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. October 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582685/
Frequently Asked Questions About DUPIXENT® (dupilumab). Accessed March 11, 2024. www.dupixent.com. Available from: https://www.dupixent.com/frequently-asked-questions
IL-4/-13 Axis and Its Blocking in the Treatment of Atopic Dermatitis. Pappa G, Sgouros D, Theodoropoulos K, et al. J Clin Med. 2022;11(19):5633. Published September 24, 2022. doi:10.3390/jcm11195633
National Eczema Society. Dupilumab. Published February 10, 2020. Accessed March 11, 2024. Available from: https://eczema.org/information-and-advice/treatments-for-eczema/dupilumab
Pentaherbs Formula, Berberine, Gallic Acid and Chlorogenic Acid in Atopic Dermatitis-Like Skin Inflammation. Tsang MS, Jiao D, Chan BC, et al. Molecules. 2016;21(4):519. Published April 20, 2016. doi:10.3390/molecules21040519
Tian J, Zhang D, Yang Y, et al. Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study. Br J Dermatol. 2023;190(1):55-61. doi:10.1093/bjd/ljad339
Ming X, Yin M, Liyan W. Antibacterial and Anti-Inflammatory Potential of Chinese Medicinal Herbs: Lonicerae flos, Lonicerae japonicae flos, Scutellaria baicalensis Georgi, and Forsythia suspensa. Nat Prod Commun. 2022;17(11). doi:10.1177/1934578X221136673
Biologic Medications and Side Effects. WebMD. Available from: https://www.webmd.com/arthritis/psoriatic-arthritis/biologic-medications-and-side-effects
Facts About Current Good Manufacturing Practice (CGMP). U.S. Food and Drug Administration (FDA). Available from: https://www.fda.gov/drugs/pharmaceutical-quality-resources/facts-about-current-good-manufacturing-practice-cgmp
Food Allergy Chinese Herbs. Evherbs. Available from: https://www.evherbs.com/food-allergy-chinese-herbs
Dupilumab Injection. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/drugs/20590-dupilumab-injection
Juliette Aiyana, is an internationally respected specialist in Traditional Chinese Medicine (TCM) and natural holistic health. She is a nationally board-certified and New York State-licensed acupuncturist with a Master's Degree in TCM. She is professional member of the National Eczema Association and trained in identifying skin disease in richly pigmented skin. Practicing since 2001, she specializes in treating chronic, stubborn and mystery diseases, including dermatology, autoimmune disorders, allergies, digestive disorders, chronic fatigue, viral diseases, menstrual and pelvic health, and more. She is dedicated to identifying the root cause of diseases, and empowering people to reclaim agency over their health. Juliette’s health consultations are available virtually via Zoom to people in the US and CA.
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