Expert Consensus on Advanced Topical Nonsteroidal Therapies for Chronic Hand Eczema
March 2026 | Volume 25 | Issue 3 | 228 | Copyright © March 2026
Published online February 26, 2026
April W. Armstrong MD MPHa, Yvonne Nong MDa, Christopher G. Bunick MD PhDb, Raj Chovatiya MD PhDc,d, Adelaide A. Hebert MDe, Leon Kircik MDf,g, Jiade Yu MDh, Mark G. Lebwohl MDf
aDivision of Dermatology, University of California Los Angeles, Los Angeles, CA
bDepartment of Dermatology, Yale School of Medicine, New Haven, CT
cRosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL
dCenter for Medical Dermatology + Immunology Research, Chicago, IL
eUT Health McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX
fDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
gDepartment of Dermatology, Indiana University School of Medicine, Indianapolis, IN
hDepartment of Dermatology, Virginia Commonwealth University School of Medicine, Richmond, VA
Abstract
Background: Chronic hand eczema (CHE) is a common, heterogeneous inflammatory skin disease associated with substantial symptom burden, impaired hand function, reduced quality of life, and work-related disability. Despite its clinical impact, evidence-based guidance for long-term, steroid-sparing topical management has been limited.
Objective: To develop expert consensus statements on the role of advanced topical nonsteroidal therapies in CHE management.
Methods: A panel of seven dermatologists with expertise in CHE conducted a structured literature review, prioritizing CHE-specific trials when available. Evidence was evaluated using the Strength of Recommendation Taxonomy (SORT). Draft statements were refined through a Delphi consensus process, with consensus predefined as ≥75% agreement.
Results: The panel reached consensus on six statements addressing advanced topical nonsteroidal therapies in CHE. These agents were recognized as important steroid-sparing options appropriate for long-term use. Delgocitinib cream is currently the only topical therapy with CHE-specific regulatory approval and is considered an appropriate first-line advanced topical treatment.
Clinical trial data show that advanced topical nonsteroidal therapies provide rapid and sustained improvements in erythema, scaling, fissuring, pruritus, and pain. Delgocitinib demonstrated sustained improvements in patient-reported outcomes and superior health-related quality-of-life benefits compared with oral alitretinoin in severe CHE. Treatment has also been associated with improved work productivity and daily functioning. These therapies have favorable safety profiles, with adverse events largely limited to local reactions, minimal systemic exposure, and no requirement for routine laboratory monitoring. Other topical nonsteroidal agents may have a role in selected patients, although CHE-specific data remain limited.
Conclusion: This consensus provides practical guidance supporting individualized, steroid-sparing CHE management while identifying areas for future research.
INTRODUCTION
Chronic hand eczema (CHE) is a common, heterogeneous inflammatory condition affecting the hands and wrists. Etiologic and morphologic patterns, such as irritant, allergic, atopic, hyperkeratotic, vesicular, and mixed presentations, are often described; however, these features frequently overlap in clinical practice and are generally considered within the broader diagnosis of CHE.1,2 The European Society of Contact Dermatitis defines CHE as hand eczema lasting at least three months or recurring two or more times within a year.3-5 As a result, while descriptive patterns may be helpful for clinical context, management is often guided by the overall diagnosis of CHE rather than strict subtyping. The scope of this work is limited to CHE as defined by these criteria and does not include pediatric disease.
CHE has substantial personal and societal impact. Both U.S. Department of Labor and European occupational health data identify hand dermatitis as a major contributor to work absenteeism and productivity loss.6-8 Despite this burden, only one topical therapy is currently approved for CHE, leaving clinicians with limited options for a condition that often requires long-term management (Table 1).9 Although several advanced topical nonsteroidal agents are used in practice, evidence specific to CHE remains limited, and clinicians often extrapolate from studies of atopic dermatitis or contact dermatitis. Small studies suggest potential benefit but highlight the need for clearer guidance.10
