Anzupgo (delgocitinib) cream 2% is a topical pan–Janus kinase (JAK) inhibitor for the treatment of moderate-to-severe chronic hand eczema (CHE) in adults who have had an inadequate response to topical corticosteroids or for whom such treatments are not advisable. It is currently the only therapy with a specific FDA-approved indication for CHE. 

Anzupgo works by inhibiting JAK1, JAK2, JAK3, and tyrosine kinase 2, which are key components of the JAK-STAT signaling pathway. This pathway regulates the activity of multiple pro-inflammatory cytokines involved in skin inflammation. By blocking JAK activation, Anzupgo reduces downstream STAT signaling, which in turn decreases the expression of cytokine-responsive genes that drive inflammatory responses in the skin. 

The recommended dosing for Anzupgo is twice-daily application to affected areas of the hands and wrists only. The total amount applied should not exceed 30 grams over a 2-week period or 60 grams per month. The medication is not intended for use on other parts of the body and should not be used in combination with other JAK inhibitors or potent immunosuppressive therapies. 

In clinical trials, Anzupgo demonstrated a safety profile generally comparable to vehicle. Adverse reactions occurring in ≤ 1% of patients included application site pain, paresthesia, erythema, pruritus, and bacterial skin infections. Instances of leukopenia and neutropenia were also reported. Most adverse events were mild or moderate in intensity. For dermatologists, Anzupgo offers a new therapeutic option for a population with limited alternatives. Chronic hand eczema can be persistent, painful, and resistant to conventional treatments. With its targeted mechanism of action and topical formulation, Anzupgo provides a nonsteroidal alternative designed specifically for this condition, helping to fill a longstanding gap in the management of moderate-to-severe CHE.