Biologic therapy for psoriasis or eczema
Targeted medicines, usually given by injection, that switch off a specific part of the overactive immune response in severe psoriasis or eczema when other treatments have not worked.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Biologics target one specific immune signal to calm severe psoriasis or eczema when other treatments have failed; they control, not cure.
- Because they affect the immune system, you need screening before starting (including tuberculosis and hepatitis) and regular monitoring.
- The main risk is infection, so you need to know the warning signs and what to do if you become unwell.
- Treatment is usually long-term, and the condition can return if it is stopped; live vaccines and pregnancy plans need discussing.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can clear or greatly improve severe psoriasis or eczema that other treatments could not control
People with active serious infection, untreated tuberculosis or active hepatitis until these are addressed.
Some people notice early improvement; for others it takes longer. Injection-site reactions, if they occur, are usually mild and settle.
Completed screening and up-to-date vaccinations before starting.
Some people notice early improvement; for others it takes longer. Injection-site reactions, if they occur, are...
The team reviews how much your skin and quality of life have improved, with blood tests, and decides whether to...
Regular review and blood tests continue to check the treatment is still working and safe, and to pick up side...
The condition can gradually return after stopping. Any change is planned with your team rather than done abruptly...
What is biologic therapy for psoriasis or eczema?
Biologics are medicines made from living cells that target one specific part of the immune system driving a skin condition. Instead of dampening the whole immune system, they block a particular signal, which can calm severe psoriasis or eczema while often being better tolerated than older tablets.
They are used for severe psoriasis, or moderate-to-severe atopic eczema, when creams, light therapy and usually other tablets have not worked well enough or are not suitable. Because they are powerful and expensive, the NHS uses set criteria, including how severe the condition is and how much it affects your life, measured with scores such as PASI for psoriasis or EASI for eczema.
Most biologics are given as an injection under the skin, which you or a nurse can do at home, every few weeks. A few are given as a drip (infusion) in hospital. Biosimilars are highly similar, equally effective versions of established biologics.
Because biologics affect the immune system, they need screening before you start (including for tuberculosis and hepatitis) and ongoing monitoring. They control the condition rather than cure it, and the skin can flare again if treatment stops.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Biologics vs older systemic tablets
| Biologics | Older tablets (e.g. methotrexate) | |
|---|---|---|
| How given | Injection or infusion | Usually tablets |
| Target | One specific immune signal | Broader immune effect |
| Monitoring | Screening plus regular review | Frequent blood tests |
| Main concern | Infection risk, cost | Liver, blood and other organ effects |
Biologics are usually used after older treatments have been tried or found unsuitable, because of cost and the need for screening.
Preparing for your treatment
- Expect screening before you start: blood tests, and checks for tuberculosis (often a special blood test in hospital) and hepatitis.
- Tell your team about any recent or recurrent infections, including TB contact, and any history of cancer.
- Make sure your vaccinations are up to date beforehand, as live vaccines are generally avoided once on treatment.
- Tell your clinician if you are pregnant, planning pregnancy or breastfeeding, so a suitable choice can be made.
- Ask how the medicine is given, whether you will inject at home, and how it should be stored (often in a fridge).
- Mention all other medicines, as some combinations increase infection risk.
What happens
Before starting, the dermatology team checks you meet the criteria and arranges screening: blood tests, a tuberculosis check (often an IGRA blood test, sometimes a chest X-ray) and hepatitis tests, to make sure it is safe to switch off part of your immune response.
Most biologics are then given as an injection just under the skin using a pre-filled pen or syringe. You may be taught to do this yourself at home, or a homecare nurse may help, with the frequency depending on the drug (from weekly to every few weeks or longer). A few biologics are given as a drip in hospital over a longer session.
After starting, you are reviewed and have blood tests, often at around 3 to 4 months and then at least every 6 months, to check the treatment is working and safe. The team also checks how your skin and quality of life have improved, and whether to continue.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People with active serious infection, untreated tuberculosis or active hepatitis until these are addressed.
- Some biologics are unsuitable with certain heart, neurological or cancer histories, depending on the drug.
- Biologics are usually not appropriate for mild disease that other treatments can control.
- Certain drugs are avoided in pregnancy or breastfeeding, so an alternative may be needed.
Delay or rearrange if…
- Pre-treatment screening (TB, hepatitis, bloods) is incomplete.
- You have an active infection that needs treating first.
- You are due a live vaccine that should be given before starting.
- You are pregnant or planning pregnancy and the proposed drug is unsuitable.
Alternatives to discuss
- Optimising topical treatments and phototherapy first.
- Older systemic tablets such as methotrexate, ciclosporin or acitretin (psoriasis), weighing their risks.
- A different biologic or biosimilar if the first is unsuitable or stops working.
- Conservative management if disease is milder than it seems.
- Joint care with rheumatology if arthritis is the main problem.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can clear or greatly improve severe psoriasis or eczema that other treatments could not control
- Often works when older tablets have failed or caused side effects
- Can substantially improve quality of life, sleep, itch and confidence
- Some biologics also help associated psoriatic arthritis
- Targeted action may avoid some whole-body side effects of older medicines
Risks & complications
- Reactions at the injection site such as redness, soreness or swelling
- More frequent colds and minor infections, including chest and sinus infections
- Headache or tiredness
- Cold sores or other viral flare-ups in those prone to them
- More significant infections that may need antibiotics or a treatment break
- Eye inflammation (conjunctivitis), particularly with some eczema biologics
- Worsening or new patches of eczema or psoriasis with certain drugs
- Abnormal blood-test results needing review
- Serious infections, including reactivation of tuberculosis or hepatitis
- Severe allergic reactions, especially with infusions
- Reactivation of other latent infections, or rare effects depending on the specific drug
The central trade-off with biologics is powerful control of the skin against a raised risk of infection, because you are switching off part of the immune defence. This is why tuberculosis and hepatitis screening before starting, up-to-date vaccinations and ongoing monitoring all matter. Different biologics carry slightly different risks, so ask which specific infections yours is linked with, what to do if you become unwell or need surgery, and how it affects pregnancy and vaccinations.
Published figures to discuss
How well a biologic works, and the chance of side effects, varies by the specific drug, the condition, its severity and individual factors. Infection is the key safety concern; published serious-infection rates from trials and registries vary and depend on the drug, other medicines and underlying health. These figures come from selected populations and may not reflect your personal risk, so exact percentages are not given here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Serious infection on biologics | Reported as a low but real excess over background in psoriasis studies; rates vary by drug | Absolute risk depends on the medicine, age, other conditions and concurrent immunosuppression, so screening and monitoring are used to reduce it. | Risk of serious infections in psoriasis patients on biologics: systematic review — medRxivmedrxiv.orgSource-linked context |
| Good skin response | Common with modern targeted medicines, but drug- and disease-specific | Psoriasis trials often use PASI response, while eczema trials use EASI/IGA-style outcomes, so headline percentages are not directly comparable between conditions. | Guide sourcesClinical context |
| Loss of response over time | Recognised | Some patients need dose optimisation, adherence review, switching within class, or switching to a different target if benefit fades. | Guide sourcesClinical context |
| Screening or monitoring finding that delays treatment | Recognised | TB/hepatitis results, abnormal blood tests, live vaccines, active infection or pregnancy planning can change the start date or drug choice. | Risk of serious infections in psoriasis patients on biologics: systematic review — medRxivmedrxiv.orgSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery, but it takes time to see how well the medicine works, and ongoing monitoring is part of treatment rather than a one-off.
- Gradual improvement in the skin over weeks to a few months rather than overnight
- Mild, settling reactions where you inject
- Picking up the occasional cold or minor infection more easily
- Needing regular blood tests and reviews
- Carrying on with normal daily life between doses
Aftercare
- Learn the injection technique and storage carefully if injecting at home, and keep a sharps bin.
- Watch for signs of infection and seek advice early if you become unwell or feverish.
- Keep up monitoring blood tests and review appointments.
- Tell any other healthcare professional, including before surgery or dental work, that you are on a biologic.
- Avoid live vaccines unless your specialist has advised otherwise, and keep other vaccinations up to date.
- Carry a treatment or alert card if given one, so others know you are on an immune-affecting medicine.
- Do not stop the medicine suddenly without advice.
- Screening (TB, hepatitis, bloods) completed before starting
- Vaccinations brought up to date
- Injection technique and fridge storage understood
- Sharps bin and homecare arrangements in place
- List of infection warning signs and who to call
- Treatment or alert card carried
- Monitoring blood tests and reviews booked
⚠ Get urgent help if…
- A high temperature, shivering, or feeling very unwell (possible serious infection) — seek urgent advice
- A persistent cough, night sweats or weight loss (possible tuberculosis)
- Yellowing of the skin or eyes, or dark urine (possible hepatitis)
- Spreading redness, pain or pus, or a wound that will not heal
- Signs of a severe allergic reaction during or after an infusion: swelling, breathing difficulty, rash
- A new, changing or non-healing skin lesion
- Painful, red or sticky eyes, especially on an eczema biologic
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is clearer, more comfortable skin and much less itch, with a real improvement in daily life, often when nothing else has worked. Many people on biologics achieve a large reduction in their psoriasis or eczema, though the degree of response varies between people and between drugs.
Biologics do not cure the underlying condition. If treatment is stopped, the skin can return, and some people gradually lose response to a particular drug over time and need to switch. Results are kept under review rather than assumed to be permanent.
Many people stay well on the same biologic for years, but response can fade over time, or side effects or infections may force a change. Treatment continues as long as it is helping and safe, and is reviewed regularly. Switching to another biologic is common and often successful if the first stops working.
Related tests, treatments or support
Biologics are sometimes used with topical treatments, and occasionally alongside other medicines, though combinations that further raise infection risk are used cautiously. People with psoriatic arthritis may be managed jointly with rheumatology, and some biologics treat both skin and joints. Live vaccines are generally avoided while on treatment.
Follow-up & long-term care
After starting, you are typically reviewed at around 3 to 4 months and then at least every 6 months, with blood tests, to confirm the treatment is working and safe. The team monitors for infections and side effects, checks your skin and quality of life, and decides whether to continue, adjust or switch. Report infections or feeling unwell promptly between reviews.
- Ongoing infection vigilance and prompt reporting of feeling unwell
- Regular monitoring blood tests and specialist reviews
- Keeping non-live vaccinations up to date and avoiding live vaccines unless advised
- Telling other clinicians about the biologic before surgery, dental work or new medicines
- Reviewing pregnancy plans and contraception where relevant
- Correct home storage and injection technique
Repeat, follow-on and what comes next
- Switching between biologics is common if the first does not work well enough or stops working.
- Doses or intervals may be adjusted, and treatment may be paused for infection, surgery or pregnancy.
- Loss of response over time can happen and is managed by changing drug rather than escalating blindly.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Completed screening and up-to-date vaccinations before starting.
- Clear written infection advice and a named urgent contact.
- Reliable monitoring blood tests and regular specialist review.
- A treatment or alert card and joined-up care with other clinicians.
- Planned, supported switching if the drug fails, rather than abrupt stopping.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The specific biologic or biosimilar chosen, as drug costs vary widely
- Whether it is given by home injection or hospital infusion
- Screening tests before starting (TB, hepatitis, bloods, sometimes chest X-ray)
- Ongoing monitoring blood tests and specialist reviews
- Homecare delivery and nurse support if used
- How long treatment continues, as this is usually long-term
- The specific drug and how it is given
- All pre-treatment screening and its cost
- Ongoing monitoring blood tests and review appointments
- Homecare, delivery and storage arrangements
- What happens, and the cost, if the drug needs switching
- Who to contact urgently if you develop an infection or reaction
On the NHS? Biologics are available on the NHS for severe disease meeting set criteria, usually after other treatments have been tried; private access may be possible but the same screening and monitoring requirements apply.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Starting without proper TB, hepatitis and blood screening.
- No clear explanation of infection warning signs or what to do when unwell.
- Vaccination status and live-vaccine rules not discussed.
- Pregnancy and breastfeeding implications not covered with people who could conceive.
- No plan for monitoring or for what happens if the drug fails.
Marketing red flags
- Promoting biologics as a cure for psoriasis or eczema.
- Offering them without the required screening and monitoring.
- Downplaying infection risk or the need for ongoing review.
- Pressure to start an expensive biologic without trying appropriate alternatives.
- Guarantees of complete, permanent clearance.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which specific biologic are you recommending, and why this one for me?
- What infections is this drug particularly linked with, and what are the warning signs?
- What screening and monitoring will I need before and during treatment?
- What should I do if I get an infection or need an operation?
- How will this affect vaccinations, pregnancy or breastfeeding?
- What happens if it does not work or stops working over time?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will a biologic cure my psoriasis or eczema?
Why do I need TB and hepatitis tests before starting?
Do I have to inject myself?
Are biologics available on the NHS?
Can I have my usual vaccinations?
What if I want to start a family?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE CG153 — Psoriasis: assessment and management (systemic biological therapy) British Association of Dermatologists — Biologic therapies (patient information) University Hospitals Sussex NHS — Biologics and biosimilar treatment for skin conditions Risk of serious infections in psoriasis patients on biologics: systematic review — medRxiv
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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