Treating Chronic Hand Eczema with Upadacitinib: Insights from Clinical Trials and Real-World Experience
July 2025 | Volume 24 | Issue 7 | 702 | Copyright © July 2025
Published online June 30, 2025
Omar Alani ScBa, Lara Shqair BSb, Walter J. Liszewski MDc, Henry Yu PA-Cc, Iyla Draw BA MBEd, Samer Wahood BAe, Fabrizio Galimberti MD PhDf, Beth Sweney PA-Cg, Sabine Obagi BAh, Andrew Mastro PA-Ci, Diego Dasilva MDj, Christopher G. Bunick MD PhDk
aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bDepartment of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
cWest Derm Center, Bronx, NY
dDivision of Dermatology, University of Louisville School of Medicine, Louisville, KY
eDepartment of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI
fDepartment of Dermatology, Conway Medical Center Conway, SC
gRiver City Dermatology, Ada, MI
hDivision of Dermatology, University of Arizona College of Medicine, Tucson, AZ
iIllinois Dermatology Institute, Chicago, IL
jForefront Dermatology & Eastern Virginia Medical School, Virginia Beach, VA
kDepartment of Dermatology, Yale School of Medicine, New Haven, CT
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.
INTRODUCTION
Chronic hand eczema (CHE) is a common and often relapsing, chronic inflammatory skin condition with an estimated prevalence of 4% and a lifetime prevalence of 14.5% in the general population.1,2 It typically presents with dry, scaly, and pruritic lesions on the palms, fingers, and backs of the hands, and also may be accompanied by vesicles, fissures, and edema.3 The etiology is often multifactorial, involving irritant or allergic contact dermatitis or representing a manifestation of atopic dermatitis (AD).4 Around one-third of patients with CHE had a history of AD. On the other hand, patients with AD are significantly more likely to develop CHE, and up to 60% of patients with active AD report hand involvement.2,5
CHE is defined as hand eczema that lasts for more than 3 months continuously or occurs at least twice within a 12-month period.1 The physical symptoms of CHE can severely impact patients’ quality of life, particularly when the condition interferes with work or daily activities. Individuals in occupations that involve frequent hand washing, exposure to chemicals, or use of gloves are especially vulnerable to
