EN
When atopic dermatitis comes up, the conversation almost always comes down to one thing: the itch. Not the look of the skin, not the dryness, but the fact that sleep is impossible, that the scratches appear during the night and that in the morning it all starts again. For years doctors had no drug aimed at the itch itself: they treated the inflammation and hoped the itch would follow. Over the past decade that has changed, and one drug of this new line — nemolizumab — has been authorised in the European Union since 2025.
Why the itch became a target in its own right
Atopic dermatitis is a chronic inflammatory skin disease affecting several per cent of the population in developed countries. At its root is a combination of an impaired skin barrier and an excessive reaction of the immune system. A vicious circle arises: inflammation causes itching, scratching damages the barrier further, irritants get in through the damaged skin, and the inflammation grows.
The basis of treatment has long been, and remains, topical: moisturising and anti-inflammatory ointments, above all corticosteroids. They work, but used for long periods over large areas they have their price: the skin thins. Hence the interest in acting not on inflammation in general but specifically on the signal that causes the itch.
That signal turned out to be interleukin-31 — a substance released by immune cells which binds to receptors on the nerve endings in the skin. Nemolizumab is an antibody that blocks that receptor. In plain terms, it intercepts the message “this itches” before the brain receives it.
What has changed in recent years
The first publications on nemolizumab were early clinical trials in small groups: the drug was then referred to by a code and the wording came down to “promising, we shall see”. That stage is now past. Large phase-three studies — the ARCADIA programme in atopic dermatitis and OLYMPIA in prurigo nodularis — have been completed, and on their basis the drug has been registered.
In the United States it was approved in 2024 under the name Nemluvio; in the European Union the Commission’s decision came in February 2025: for moderate to severe atopic dermatitis in adults and adolescents from the age of 12, and for prurigo nodularis in adults. It was approved in the United Kingdom and Switzerland at the same time. In Germany the drug has been available since 2025, and the Federal Joint Committee (G-BA) carried out its standard assessment of additional benefit for it in the same year. It is given by subcutaneous injection every four weeks.
No less important, nemolizumab did not arrive alone. By 2026 a whole group of current drugs is in use in Germany for moderate to severe atopic dermatitis: the biologicals dupilumab, tralokinumab and lebrikizumab, each with its own point of action, and oral Janus kinase inhibitors. The question has therefore shifted: not “is there anything besides steroid ointments” but “which of these suits this patient”.
What this changes for the patient
The practical point is that severe atopic dermatitis has ceased to be a condition where the choice is limited to topical treatment and general advice. There is now something to choose between: the drugs differ in mechanism, in the way they are given, in how often, in age limits and in their side-effect profiles. For someone whose main complaint is exactly the exhausting itch and the sleeplessness, having a drug aimed at the itch widens that choice.
The decision on systemic therapy in Germany is taken by a dermatologist after assessing the severity of the course, the area affected, the effect of the disease on sleep and daily life, and any accompanying conditions — asthma or allergic rhinitis, for instance, which often go with atopic dermatitis.
What this does not yet mean
None of these drugs cures atopic dermatitis: what is at issue is control of a chronic disease, not its removal. They do not do away with basic skin care — moisturising remains part of the regimen in any case. They are prescribed not for every form but for moderate and severe disease, where topical treatment is not enough. Response to a drug is individual, and doctors cannot yet predict in advance which will suit whom — sometimes the regimen has to be changed. And, as with any drug affecting the immune system, they have their limits and unwanted effects, which are discussed before treatment begins rather than after.
This material is for information only and does not replace a consultation with a doctor. The choice of drug, the indications and the contraindications are determined only after an examination by a dermatologist in person.