137: Before Starting Dupixent (Or Other Biologic Medications)...

If you’ve considered starting Dupixent or some other type of biologic medication for your rashes, here’s something to consider.

Problems (that aren’t significant enough to be major issues yet) can be lurking under the surface and go unnoticed.

If a biologic medication works, symptoms should go away.

That’s a great thing for your confidence, peace of mind, and daily level of comfort.

But it can cause you to miss clues (aka. symptoms) that need attention sooner rather than later.

In today’s episode, I’m sharing why symptoms are like your car’s “check engine” light AND how this all played out for a client in real life.

My client wanted to share her experience to inspire you to “take a look under the hood” to make sure there’s nothing else going on that does need some TLC.

Because once you start a biologic (and it works), you lose out on using your symptoms as a guide towards better health.

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In this episode:

  • Isn’t it a good thing to block inflammation that’s wrecking your skin?
  • Symptoms are like your car’s “check engine” light
  • Jessica’s experience living with eczema (and why she was recommended a biologic)
  • Digging into Jessica’s case revealed deeper issues
  • Why you should get your system checked thoroughly before turning to a biologic
  • Words of wisdom from my client Jessica


If Jessica had taken a biologic (assuming it cleared up her skin), she would have never known about any of the other issues hiding under the surface.

Symptoms aren’t meant to mentally and emotionally devastate you, nor make you feel like you’re at war with your body.

Stop sign and empty road

Before Starting Dupixent (And Other Biologics) For Eczema (FULL TRANSCRIPT)

Welcome back to episode #137 of the Healthy Skin Show!

In today’s episode, I want to share with you why taking a look at your system before starting a biologic medication like Dupixent is so important.

The reason I say this is because biologic drugs essentially block certain inflammatory pathways that can drive eczema (and there are other types used for psoriasis).

But isn’t it A GOOD THING to block inflammation?

Yes and no.

It’s good to stop symptoms that are driving you nuts especially given that there is an inflammatory component to many skin rash conditions.

But it could also be a bad thing in that you’re shutting down a natural “alarm” system so-to-speak that your body uses to tell you that something is wrong.

Without it working, things can potentially go awry.

That’s why it’s imperative to fully assess your body and its biochemical systems ahead of time. To illustrate my point, I’m going to share a client case to give you some real-life insight.

One point that I want to make here is that this isn’t about whether or not you should use Dupixent (or any other biologic medication) if it’s been prescribed by your doctor.

That’s a very personal decision only you can make.

There is a time and place for medication.

Instead, I’d like you to understand why it might be better to do a thorough check of your system first to see if some areas are in need of some TLC beforehand.

Car check engine light

Why Inflammation Is Like Your Car’s “Check Engine” Light

Before I dive into my client’s case, I want to explain the significance of inflammation and symptoms (at least from my perspective as a clinical nutritionist).

A lot of people find symptoms like what many of us with chronic skin issues experience to be incredibly annoying, embarrassing, frustrating, depressing, and even angering.

Symptoms aren’t meant to mentally and emotionally devastate you.

That outlook puts you at war with your body.

It makes you think that your body is out to get you.

And it makes you feel cursed and damned.

But that’s NOT what’s going on, I promise you.

After my own health experiences and training, I now realize that symptoms are your body’s way of communicating with you. I’ve talked about this on the podcast before.

I wish my body would just spit out a tape that said exact what was wrong, but it doesn’t work that way.

Instead the symptoms can be all over the place and sometimes vague (and unfortunately easy to ignore until you no longer can because of how uncomfortable you are).

Think of symptoms as something similar to the “check engine” light in your car.

Frankly, I never know what the heck is really wrong with my car when it comes on. It’s kind of vague to some degree without the help of my mechanic who has instruments that help him look deeper and figure out the issue.

But what would the consequence be if I ask the mechanic to cut the power to the “check engine” light without evaluating the car’s system?

Well, I could end up stranded by the side of the road one day because something in the engine broke and didn’t get the attention it required beforehand.

I believe that your body uses symptoms to tell you something needs attention under the surface. 

That’s why viewing your symptoms as a communication tool makes a lot more sense. And it’s much more empowering to know that your body isn’t working against you just to make your life difficult.

Skin cream

Before Taking Dupixent: A Case Study

To demonstrate what I mean by all of this, I figured I’d share one of my cases from my private practice with you.

My client, Jessica, gave me permission to share her journey to give you hope, but also to serve as an eye-opener of why looking deeper is so important.

Jessica came into my practice with severe eczema. She’d had it as a kid, but it eventually died down only to return with a vengeance in 2017.

She’d seen multiple dermatologists and tried a lot of different approaches including the elimination of gluten, dairy and eggs from her diet (without real improvement).

Jessica shared with me that a year ago, her skin was so “horrifically bad” that she had to take a week off from work.

She felt like she’d lost all of last year.

Because she wasn’t getting sustainable improvements with steroid creams, her doctor had recommended Dupixent.

She had already filled the prescription, but was hesitant and wondered if she should see if something else was going on. That’s when she came across Skinterrupt.com and my practice!

Rather than just thinking that Jessica had a skin problem, I dug a lot deeper.

I found that she had…

  • Thyroid problems triggered after her first child was born
  • Easily breakable nails
  • Rashes (some of which were in areas like her armpits that made me wonder if yeast was possibly an issue)
  • Daily fatigue
  • Dry scalp
  • Dry eyes
  • Migraines

Additionally, I reviewed her labs for the past few years and determined that some nutrients in her system were really suboptimal.

One example was her vitamin B12 level which had been steadily dropping for a couple of years!

Other nutrients like her Vitamin D, Vitamin A, and Magnesium were suboptimal while a non-specific inflammatory marker called C-reactive protein was high.

And her doctor was keeping an eye on her Lipid panel because her cholesterol, LDL and triglycerides were all high.


Other functional testing done helped us determine that there was an imbalance of her gut microbiome which could be driving some of the inflammation.

I worked with Jessica to develop a plan to address these issues with…

  • Diet tweaks (for her specifically due to testing, I advised her to remove fermented foods for a period of time
  • Rebalancing her gut bug community
  • Phase 2 liver detox support
  • Appropriate supplementation to get critical nutrients into her system
  • Stress management techniques to help keep her system out of fight-or-flight mode

Beach in Hawaii

How Jessica’s Hard Work Helped Her Skin (And Body)

Before I share with you the changes that Jessica experienced, I want to be clear in stating that this was not an overnight journey.

A lot of people look for the next ONE THING to fix them only to be disappointed.

Chronic skin issues often hide several problems under the surface from my experience as a clinical nutritionist.

That’s why I always remind you that it’s not typically just ONE issue.

There’s usually 3 to 5 different root causes that must be addressed that often take time. It took time to get where you are and so it takes time to unwind many of these issues.

With all that said, over several months, her skin began to change for the better.

Then she went to Hawaii and was able to be out with her family in the sun and enjoy the trip! This was in stark contrast to the previous summer of 2018 where she couldn’t even go out in the sun because of how bad her skin was!

Exercise and sweating weren’t triggering flares anymore.

After working together for several months, she had gone from using topical steroids for periods of two weeks on and two weeks off to only needing some help from Elidel only a couple of days over an entire month.

This was a big improvement in her eyes!

And we were able to support her lipid panel and many of the other nutrient markers to come back into appropriate optimal ranges.

Woman driving

Why It’s Worth Looking Deeper At What’s Driving Inflammation

To this day, Dupixent has stayed on the shelf of Jessica’s fridge.

She was never opposed to using it.

But it was important to her that she didn’t miss anything before going that route.

Jessica has shared with me several times on her journey that if she’d just taken the Dupixent (assuming it cleared up her skin), she would have never known about any of the other issues hiding under the surface.

Just the one example of her vitamin B12 level which had been steadily dropping…

She was glad to get that rectified as B12 deficiency can have very unpleasant symptoms, some of which are permanent like nerve damage in the extremities.

Is she 100% better?

No, there’s certainly little issues that pop up here and there for her.

But overall, her quality of life has dramatically improved.

She’s able to enjoy so much more of her life without being controlled by her rashes.

I asked Jessica if she had anything specific that she wanted me to share with you on your journey.

She wants you to know that “it is a journey to find what are the root causes of your skin issues. The quick fixes (like topical steroids) are just a band aid that help with the symptoms. Be patient along the way and realize your healing journey is not going to be linear.”

If you’re wanting to dive deeper, check out if my virtual clinical practice is a good fit for you!

And it is okay if you’ve already started on a biologic medication. You can certainly look deeper, but know that you might not be able to count on using your symptoms as a guide since your body’s response is altered. This is where having conventional and functional lab testing available is crucial.

I hope this episode gives you some much needed insight about what to consider before diving straight into using biologic medications.

If you were to take away just ONE thing, it would be to do a really comprehensive check of your system before starting a medication like this.

That way, problems lurking under the surface that aren’t yet causing major issues don’t hopefully turn into big issues.

Ultimately the choice to use (or not use) biologic medications is incredibly personal and should be made after extensive conversations with your doctor and familiarizing yourself with the potential side effects that could pop up.

Leave your questions, comments or experience with Dupixent or other biologics below so we can continue this conversation!

Because there’s a push to try biologics when steroid creams don’t seem to work well enough, I felt like this message is critical to hear since looking deeper isn’t really part of the process.

So make sure to share this episode with people in our community who are thinking about taking the biologics plunge so that they have the opportunity to take at their system beforehand.

Thank you so much for tuning in and I look forward to seeing you in the next episode!

If Jessica had taken a biologic (assuming it cleared up her skin), she would have never known about any of the other issues hiding under the surface.

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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