Dupilumab is a monoclonal antibody biologic that blocks IL-4 and IL-13 receptors. It does not go through the hepatic CYP450 enzyme system, so the risk of drug interactions is lower than with small-molecule drugs. However, some herbal ingredients (Licorice, Huanglian, etc.) can affect CYP enzymes, and prescriptions containing hepatotoxic ingredients can, though rarely, cause changes in liver enzyme levels.

Safety checklist for combined use: ①inform your dermatologist of intent to take herbal medicine, ②always inform your Korean medicine doctor that you are receiving dupilumab, ③check liver function (AST/ALT) via blood test 4-6 weeks after starting combined use, ④record changes in skin reactions for a few days after injection. If using JAK inhibitors (oral, e.g., upadacitinib), concerns about interactions are greater and more careful consultation is needed before prescribing.

Korean Medicine Perspective

At Dongjedang, for patients using biologics, we prioritize prescriptions with low liver burden. Rather than aggressive heat-clearing and detoxifying formulas, we use blood-nourishing (補血) and skin-moisturizing (潤膚) prescriptions (Dangguiyeumja, Si-mul-tang modifications) to support skin regeneration, and actively use external treatments (herbal washes, Mapunggo) to minimize the amount of internal medicine needed. We treat sharing treatment plans with the attending dermatologist as a principle.