The FDA’s approval of delgocitinib for chronic hand eczema is shining a light on this and other regional eczemas. Next Steps in Derm, in partnership with the ODAC Dermatology Conference, interviewed Peter A. Lio, MD, FAAD, clinical assistant professor of dermatology and pediatrics at the Northwestern University Feinberg School of Medicine. Watch as Dr. Lio shares the burden of chronic hand eczema and the complexity of the components involved. Hear the latest research on other therapies for chronic hand eczema, including topical and oral JAK inhibitors. Additionally, Dr. Lio shares the link between dupilumab and eczema on the head and neck, and non-steroidal treatment options.
Further Reading
If you want to read more about chronic hand eczema, check out the following articles published in the Journal of Drugs in Dermatology:
The Utility of Delgocitinib in Chronic Hand Eczema
ABSTRACT
Chronic hand eczema (CHE) affects up to 10% of the general population and is associated with significant physical discomfort, impaired hand function, and reduced quality of life, yet effective long-term treatment options remain limited. Delgocitinib cream, a nonsteroidal topical pan-JAK inhibitor, has demonstrated high efficacy and safety in adult Phase 3 pivotal trials, significantly improving clinical signs, symptoms, and quality of life for patients across diverse CHE subtypes. Comparative studies suggest delgocitinib offers superior or similar benefits to systemic therapies like the oral retinoid alitretinoin and the biologic dupilumab, with negligible systemic exposure. These findings support delgocitinib cream as an innovative and promising topical therapy addressing a critical unmet need in CHE patient management.
ABSTRACT
Background: Chronic hand eczema (CHE) is a chronic inflammatory skin condition that affects the hands and wrists
causing itching, dryness, cracking, and pain. It often affects people with atopic dermatitis (AD) and can interfere with work and daily life. Topical therapies may have limited utility from ineffectiveness, poor adherence, or poor tolerability. Here, we evaluate oral upadacitinib (UPA) as a potential therapeutic alternative for patients with AD and refractory CHE.
Methods: This narrative review analyzed studies from PubMed, SCOPUS, and EMBASE evaluating CHE treatments. Eligible studies utilized the Hand Eczema Severity Index (HECSI), a validated clinician-reported outcome measure assessing CHE severity. HECSI-75 is the proportion of patients achieving at least a 75% improvement in clinical severity. Cases of three CHE patients from diverse demographics are presented.
Results: In two phase 3 randomized controlled trials of UPA for moderate-to-severe AD, 94.8% (803/847) and 92.6%
(774/836) of patients had CHE with HECSI assessments at baseline. Rapid improvement in CHE was observed in patients who received either dose of UPA (15 mg or 30 mg) as early as week 1 (P≤0.001 vs placebo). By week 8, up to 83% of UPA-treated patients achieved a statistically significant improvement in CHE (HECSI 75; P≤0.001 vs placebo). These benefits were sustained through week 16. Real-world clinical cases showed CHE patients experienced marked symptom relief within days of initiating UPA.
Conclusion: UPA-treated patients experienced rapid and sustained relief from CHE lesions, making it a promising therapeutic option for CHE patients for whom topical therapies are ineffective.
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