Chronic hand eczema (CHE), which affects up to 10% of the United States population annually, encompasses a diverse range of presentations. Designation of the condition as "chronic" owes to its persistence or its recurrence (at least two recurrences per year after the initial presentation).1
Primary symptoms of CHE may include erythema, scaling, fissures, and itch. The potential impact on patients of these symptoms is easy to imagine. The chronic nature of the condition only serves to intensify this negative impact. One comprehensive review linked CHE with inability to work, absenteeism, and negative impacts on health-related quality of life.2 Itch and pain attributed to CHE are associated with high rates of sleep disruption.3 Yet, data show that up to half of affected individuals have not sought medical care for the condition.2
Management of CHE can be complicated by numerous factors, including the possibility that contact irritants or allergens–including occupational exposures–contribute to the condition.2 Additionally, there have been few effective directed treatment options available for the condition, and some of the most widely used treatments have potential limitations, including systemic exposure or tolerability concerns.
A promising new agent for treating CHE was approved by the FDA in the US in August 2025 and is now available. Delgocitinib (Anzupgo) is a pan-JAK inhibitor in a topical formulation that is intended for twice-daily application.
Among the promising data reviewed in the pages ahead, a pooled analysis of phase 3 trials for delgocitinib cream 20 mg/g in moderate to severe CHE shows benefit across all CHE subtypes. Within the initial 16-week treatment period, 42.0% of patients achieved an IGA-CHE treatment success (TS) at least once, increasing to 59.9% after 52 weeks of treatment. Additionally, 66.5% of patients reached a hand eczema severity index-75 (HECSI-75) at least once by week 16, increasing to 83.5% by week 52.4
Vehicles matter!
In the case of delgocitinib for CHE, the topical cream formulation appears to have two important features. First, this vehicle is associated with reduced systemic exposure to the active drug. While oral JAK inhibitors are used safely for dermatologic and other indications, there are theoretical concerns about systemic exposure from topical JAK inhibitors. Therefore, a formulation that limits systemic exposure is welcomed by patients and prescribers alike.
Additionally, the cream formulation, which has been shown to be well-tolerated, is convenient for patients. With its twice-daily application schedule, the moisturizing cream may provide soothing benefits for inflamed skin while avoiding greasiness or dryness.
Enhanced drug development focused on CHE has brought greater attention to this somewhat common disease and its burden on affected patients. The need for safe and directed treatment is clear. Evidence shows that topical delgocitinib cream is poised to fill a gap in patient care by offering an effective therapy in a moisturizing, convenient formulation base that is well-tolerated.
Leon Kircik MD
Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Adjunct Clinical Professor of Dermatology, Indiana University School of Medicine, Indianapolis, IN; Medical Director at Physicians Skin Care, PLLC Louisville, KY; DermResearch, PLLC Louisville, KY; and Skin Sciences, PLLC Louisville, KY.
Primary symptoms of CHE may include erythema, scaling, fissures, and itch. The potential impact on patients of these symptoms is easy to imagine. The chronic nature of the condition only serves to intensify this negative impact. One comprehensive review linked CHE with inability to work, absenteeism, and negative impacts on health-related quality of life.2 Itch and pain attributed to CHE are associated with high rates of sleep disruption.3 Yet, data show that up to half of affected individuals have not sought medical care for the condition.2
Management of CHE can be complicated by numerous factors, including the possibility that contact irritants or allergens–including occupational exposures–contribute to the condition.2 Additionally, there have been few effective directed treatment options available for the condition, and some of the most widely used treatments have potential limitations, including systemic exposure or tolerability concerns.
A promising new agent for treating CHE was approved by the FDA in the US in August 2025 and is now available. Delgocitinib (Anzupgo) is a pan-JAK inhibitor in a topical formulation that is intended for twice-daily application.
Among the promising data reviewed in the pages ahead, a pooled analysis of phase 3 trials for delgocitinib cream 20 mg/g in moderate to severe CHE shows benefit across all CHE subtypes. Within the initial 16-week treatment period, 42.0% of patients achieved an IGA-CHE treatment success (TS) at least once, increasing to 59.9% after 52 weeks of treatment. Additionally, 66.5% of patients reached a hand eczema severity index-75 (HECSI-75) at least once by week 16, increasing to 83.5% by week 52.4
Vehicles matter!
In the case of delgocitinib for CHE, the topical cream formulation appears to have two important features. First, this vehicle is associated with reduced systemic exposure to the active drug. While oral JAK inhibitors are used safely for dermatologic and other indications, there are theoretical concerns about systemic exposure from topical JAK inhibitors. Therefore, a formulation that limits systemic exposure is welcomed by patients and prescribers alike.
Additionally, the cream formulation, which has been shown to be well-tolerated, is convenient for patients. With its twice-daily application schedule, the moisturizing cream may provide soothing benefits for inflamed skin while avoiding greasiness or dryness.
Enhanced drug development focused on CHE has brought greater attention to this somewhat common disease and its burden on affected patients. The need for safe and directed treatment is clear. Evidence shows that topical delgocitinib cream is poised to fill a gap in patient care by offering an effective therapy in a moisturizing, convenient formulation base that is well-tolerated.
Leon Kircik MD
Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Adjunct Clinical Professor of Dermatology, Indiana University School of Medicine, Indianapolis, IN; Medical Director at Physicians Skin Care, PLLC Louisville, KY; DermResearch, PLLC Louisville, KY; and Skin Sciences, PLLC Louisville, KY.
DISCLOSURE
Leon Kircik MD has received compensation from JDD for his editorial support.
REFERENCES
- Weisshaar E. Chronic hand eczema. Am J Clin Dermatol. 2024;25(6):909-926.
- Thyssen JP, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis. 2022;86(5):357-378.
- Zalewski A, Krajewski PK, Szepietowski JC. Prevalence and characteristics of itch and pain in patients suffering from chronic hand eczema. J Clin Med. 2023;12(13).
- Bissonnette R, Schliemann S, Gooderham M, et al. Treatment response of delgocitinib cream according to chronic hand eczema (CHE) subtypes in adults with moderate to severe CHE: results from the phase 3 DELTA 1, DELTA 2, and DELTA 3 trials. Presented at: European Academy of Dermatology and Venereology Congress; September 25-28, 2024; Amsterdam, Netherlands. Abstract 3870.
