Kilian Eyerich, MD, PhD, is chair and professor at the Department of Dermatology and Venerology of the University of Freiburg, Germany, as well as a guest professor at the Karolinska Institute in Stockholm, Sweden.

Kilian Eyerich, MD, PhD

Kilian Eyerich, MD, PhD | Image credit: International Psoriasis Council

 evaluating lebrikizumab in adults with nummular eczema has been initiated by Almirall, broadening investigation of the interleukin (IL)-13 inhibitor beyond its currently approved use in moderate-to-severe atopic dermatitis. The analysis reflects the company’s continued focus on advancing targeted dermatology therapies while also incorporating patient-centered outcome measures into clinical research.

, Kilian Eyerich, MD, PhD, Eyerich described nummular eczema as a common yet historically understudied inflammatory skin condition. The disease lacks approved targeted medications, Eyerich noted, despite its significant impact on patients’ quality of life. Nummular eczema, also known as discoid eczema, is linked with chronic pruritus, recurrent flares, disruption of sleep, and psychosocial burden, and it can occur either independently or alongside atopic dermatitis.

Eyerich speaks in the second segment of his interview about several topics, including growing challenges faced by clinicians such as patient topical corticosteroid (TCS) hesitancy, withdrawal concerns, and the need for more effective treatment options for this difficult-to-control disease:

Many clinicians still rely heavily on topical corticosteroids for nummular eczema management. What challenges do you commonly see with current treatment approaches, particularly in patients with persistent or difficult-to-control disease?

 I think it's super important that you mention this exception. I would say in the majority of patients that have a mild no eczema, topical cortical steroids are still okay as long as we don't use them regularly and at high potency in sensitive areas. The main problem with TCS these days is that in the moderate and severe patients, they won't be enough. But that's only one point. Other aspects are that many patients just don't want it anymore, especially in the case of nummular eczema. These are often elderly patients that have treated their skin for many years, and they say, 'Please, every dermatologist tells me the same: use topical corticosteroids, I used them for a couple of days. Things get a little better, but as soon as I stop, the disease comes back worse than it was before.’

That's one aspect. Then we have a lot of topical corticosteroid phobia and topical corticosteroid withdrawal syndrome in social media, so it is pretty difficult to find an agreement on shared decision-making with the patients that should be on a topical corticosteroid scheme only. Again, if they have moderate to severe variants of nummular eczema, this is typically not enough. And we do see side effects of these TCS, especially in elderly patients that already have a thin skin. They tend to have an easy bleeding, wound healing, delay, and all the side effects that TCS have. In other words, modern and specific effective treatments and nummular eczema are desperately missing at this step, especially in a population with moderate to severe variants.

The LumiNE trial includes endpoints assessing investigator global assessment, itch reduction, and quality of life. Why is it important to evaluate both clinical severity and patient-reported burden in nummular eczema studies?

 This is a general insight that we in dermatology have made over the last decade or so, that in order to make a good shared decision process and treatment regimen, we always need the two different aspects. We need the physician-based, more or less objective, score, as well as patient-reported outcome measurements and insights, and in all kinds of dermatological diseases. But even beyond dermatology, typically, treatment aims and treatment goals nowadays consist of these two different aspects. It is a modern approach to look at the outcome of IL-13 inhibition and nominal eczema, and I think it is a very important one.

 As interest grows in targeted therapies across inflammatory skin diseases, how do you see studies like LumiNE shaping the future conversation around biologic treatment strategies beyond traditional atopic dermatitis indications?

Thank you very much for this question, because it's for sure a hard one, but it's a very interesting one. What I do see, and that's my honest opinion as a dermatologist, is that we and the whole discipline learn a lot from specifically acting agents, such as biologics and antibodies, because we again come from an era where only the phenotype matters to make up the diagnosis. In reality, phenotypes are overlapping and heterogeneous, and that's most likely why we do have a substantial proportion of non-responders in all kinds of clinical trials we do in dermatology.

Now, what we have to say is that using anti IL-13 as an example here, lebrikizumab, gives us also insights into the biology underlying the diseases. As I said before, nummular eczema has an IL-13 component, but also neutrophil granulocyte component. But we do see that IL-13 component seems to be the dominant one, and by shaping these individual diseases we get a better understanding of inflammatory skin diseases in general, where we do have atopic dermatitis and its sister disease, prurigo, but also now, nummular eczema. The next step for me would then be to identify that these diseases are somehow interrelated when it comes to therapeutic choice, right?

Neutralizing IL-13 would have a very high probability of success. The step after that, that's the future of dermatology in the field of inflammatory skin diseases. As I see it, it would be that we don't necessarily crawl on the traditional disease ontology, but rather we say, this is a group of diseases responding to, for example, interleukin-13 antagonists. Using that, we may get rid of the 99% of diagnoses at the moment that will always be off-label, because they are ill-defined, we don't have good endpoints there, they may be rare, but these patients should benefit actually from the development progress that we do, and not only the patients in the few diseases where we have studies investigating specific drugs.

The quotes contained in this video summary were edited for the purposes of clarity.

Disclosures: Eyerich has previously reported personal fees from Janssen, AbbVie, Almirall, Boehringer Ingelheim, LEO Pharma, Lilly, Novartis, and Sanofi.

Almirall announces “LumiNE”, a phase III clinical study assessing the efficacy of Lebrikizumab for the treatment of nummular eczema. Almirall, S.A. January 15, 2026. Accessed May 22, 2026. 

https://www.almirall.com/news-media/newsroom/almirall-announces-lumine-phase-iii-clinical-study-assessing-efficacy

Böhner A, Jargosch M, Eyerich K, et al. The neglected twin: Nummular eczema is a variant of atopic dermatitis with codominant TH2/TH17 immune response. J Allergy Clin Immunol. 2023 Aug;152(2):408-419. doi: 10.1016/j.jaci.2023.04.009. Epub 2023 Apr 27. PMID: 37119871.

Articles

Phase 3 LumiNE trial is testing lebrikizumab, an IL-13 inhibitor, in adults with nummular eczema, extending development beyond moderate-to-severe atopic dermatitis. The condition is common yet understudied, lacks approved targeted options, and causes chronic pruritus, recurrent flares, sleep disruption, and psychosocial burden, often in older patients. Topical corticosteroids may help mild disease but are often inadequate for moderate-to-severe cases and complicated by steroid hesitancy, withdrawal narratives, and cutaneous adverse effects. Endpoints combining investigator assessment with itch and quality-of-life measures support shared decision-making and endotype-driven biologic strategies.

This segment of a Q&A interview with Kilian Eyerich, MD, PhD, highlights the signficance of the LumiNE phase 3 study on lebrikizumab.

Significance of New Phase 3 Lebrikizumab Trial in Nummular Eczema, With Kilian Eyerich, MD, PhD

Almirall has announced its launch of a phase 3 clinical trial evaluating Lebrikizumab in patients with 

, expanding ongoing lifecycle development efforts for the biologic beyond its current indication in moderate-to-severe atopic dermatitis.

 The company has said the study reflects its broader focus on advancing dermatology research through targeted therapies and more comprehensive outcome measures that incorporate patient well-being alongside clinical efficacy.

Nummular eczema is a chronic inflammatory skin disorder characterized by recurrent flares that can negatively affect quality of life through severe pruritus, sleep disturbances, and psychosocial burden. The condition may occur independently or alongside atopic dermatitis and is often difficult to diagnose.

 Although distinct from atopic dermatitis and requiring its own approach, researchers believe the diseases may share overlapping inflammatory pathways involving interleukin (IL)-13.

Lebrikizumab, a monoclonal antibody designed to selectively target IL-13, is being investigated in the phase 3 LumiNE trial, a randomized, double-blind, placebo-controlled multicenter study.

 Investigators have enrolled roughly 270 adults across approximately 60 European sites. Participants are receiving treatment for up to 48 weeks, with the study assessing efficacy, safety, and tolerability in individuals whose disease is inadequately controlled with topical corticosteroids or for whom such therapy is not appropriate. The primary endpoint will evaluate improvements in Investigator’s Global Assessment (IGA) scores for nummular eczema, while secondary measures include changes in itch severity and dermatology-related quality of life.

Kilian Eyerich, MD, PhD, chair and professor at the Department of Dermatology and Venerology of the University of Freiburg, Germany, and guest professor at the Karolinska Institute in Stockholm, Sweden, spoke with 

Given the limited treatment landscape for nummular eczema, what unmet needs in clinical practice make this phase 3 study particularly important for dermatologists?

Well, what makes it so important is that it is a prototype disease of many that are neglected in the area of inflammatory skin diseases. I think every dermatologist dreams of reclassifying eczematous diseases. As an example, you are likely very aware that there is not only atopic dermatitis, but there's also prurigo nodularis as a distinct diagnosis. Nummular eczema is one of the most frequent neglected diseases, which shares similarities with atopic dermatitis and prurigo nodularis, but still they're distinct diseases, both clinically and in terms of the pathogenesis. It is one of many diseases, which is quite frequent but understudied, and where we did not or do not have any approved therapeutic options.

That's interesting. The similarity to atopic dermatitis and prurigo nodularis seems unique, because we know the latter disease appears to be substantially impactful on patients' lives compared to eczema, for example.

Yes, and no. The driving symptom for the majority, if not all, of eczematous diseases is pruritus. In prurigo, typically, pruritus is, as you say, most bothersome, but there are also patients with atopic dermatitis and nummular eczema that have pruritus at a comparable intensity, as in prurigo. I wouldn't necessarily generalize it, although I agree with you. If you see it at a disease level, probably prurigo is the most bothersome in terms of the itch.

Additionally, although nummular eczema is distinct from atopic dermatitis, researchers have pointed to IL-13 as a shared inflammatory driver. From a mechanistic standpoint, what makes lebrikizumab a compelling candidate to study in this population?

 I would like to start a little broader than that. Because where our disease ontology comes from in dermatology is still from the eye, the pure phenotype, right? It's around 200 years old, or even older. Seeing from that perspective, nummular eczema is a distinct entity, because it comes from a very clear clinical phenotype. But the criteria to diagnose it are not hard and not objective, typically. It's a matter of hallmarks that the dermatologist brings together in order to make this diagnosis. It's just the same as with atopic dermatitis and just the same as with prurigo nodularis.

One important aspect of nummular eczema is that the heterogeneity is so high that there are phenotypes where even the best clinicians could not distinguish it from atopic dermatitis, which makes it so hard to say it's its own disease. Probably quite a few experts in dermatology wouldn't necessarily agree on that. Now, coming from the molecular point of view, it makes total sense for me to define the eczema as its own entity, because, as you say, IL-13 is the backbone immune response in all kinds of eczematous diseases. That, by the way, also includes prurigo, for example. But in the case of nummular eczema, it's not a purely mediated IL-13 disease. There is also an aspect of, for example, neutrophil granulocytes, which is an immune response that is not at all related to type 2 immunity or interleukin-13.

So there are similarities, and there is the shared backbone of IL-13, but nevertheless, there are additional aspects in the pathogenesis of nummular eczema that make it its own entity. Why is that so interesting to dermatologists? Because in these overlapping phenotypes, and we have a lot of these overlapping phenotypes, it was not quite clear whether we would be able to treat them with the specific therapy. Because if now we take IL-13 and neutralize it in nummular eczema, we would still have the component of the neutrophil granulocytes in there, so many dermatologists actually say that these overlapping entities should be treated with older, less specific therapies, such as topical corticosteroids, cyclosporine, and methotrexate.

But from a pathogenic point of view, what seems very interesting is that IL-13 is the dominant driver of nummular eczema. If you treat nummular eczema with a specific biologic against interleukin-13, you improve not only the type 2 immunity, but also the IL-13 and other aspects of inflammation. That is super important because it shows us, as dermatologists, that if we identify the dominant immune source and the driving immunity, we are actually able to treat these patients with nummular eczema just as well as patients with atopic dermatitis.

Almirall announces “LumiNE”, a phase III clinical study assessing the efficacy of Lebrikizumab for the treatment of nummular eczema. Almirall, S.A. January 15, 2026. Accessed May 21, 2026. 

Almirall is advancing lebrikizumab lifecycle development with a phase 3 program in nummular eczema, a common yet understudied eczematous disorder with substantial pruritus-driven quality-of-life impairment and no approved targeted options. The randomized, double-blind, placebo-controlled LumiNE trial plans to enroll ~270 adults at ~60 European sites, treating up to 48 weeks and assessing IGA response, itch, and dermatology-specific QoL. Mechanistically, IL-13 is viewed as a dominant driver despite disease heterogeneity and additional non–type 2 inflammatory components.

A new phase 3 study is evaluating lebrikizumab in at least 270 patients with nummular eczema over 48 weeks.
