Seminar-in-Depth: On the Verge of Better Management for Chronic Hand Eczema

Benjamin Ehst, MD, PhD, and Alexandra Golant, MD, presented an insightful session focused on the complex diagnosis and evolving treatment landscape of chronic hand eczema (CHE), a condition characterized by persistent inflammation, multifactorial triggers, and limited long-term therapeutic success.

Dr Ehst began by emphasizing that CHE, defined as hand eczema lasting more than three months or recurring twice or more within a year, is rarely caused by a single factor. He described how atopic dermatitis, allergic contact dermatitis, and irritant exposures often overlap, complicating management. Through a case example of a 64-year-old manufacturing employee with recurrent fissuring and scaling, Dr Ehst demonstrated the importance of comprehensive history-taking and patch testing to identify occupational allergens. He highlighted that the pathophysiology of CHE involves cytokine-mediated inflammation via the JAK-STAT pathway, providing a rationale for the recent wave of targeted therapies. Dr Golant echoed the need to individualize care, noting that traditional approaches, such as topical corticosteroids, calcineurin inhibitors, and systemic immunosuppressants, often fail to maintain remission once treatment is stopped.

The discussion then turned to emerging therapies offering renewed hope for this burdensome condition. Dr Golant reviewed pivotal phase 3 data from the DELTA 1 and 2 trials showing that delgocitinib cream, a topical pan-JAK inhibitor, achieved significant Investigator’s Global Assessment (IGA-CHE) responses by week 24, with nearly one-third of patients attaining clear or almost-clear skin in the long-term DELTA 3 extension. Dr Ehst highlighted similar promise from ruxolitinib cream, which produced rapid reductions in itch and eczema severity by day 7 in phase 2 studies. Additional data from the LIBERTY AD-HAFT trial demonstrated that dupilumab significantly improved hand and foot eczema outcomes, while interim tralokinumab results suggested parallel benefit without new safety concerns. Both speakers underscored the favorable tolerability profiles of these agents, marking a major shift from chronic steroid reliance toward precision-driven.