**Advancing Chronic Hand Eczema Treatment: Moving Beyond Steroids to Innovative Approaches with Insights from Raj Chovatiya, MD, PhD, MSCI**

October 26, 2024

Breakthrough Treatment for Chronic Hand Eczema Gains FDA Approval

A New era In Dermatology Has Begun With The Approval Of A Novel, Steroid-Free Therapy For Chronic Hand Eczema.

For Millions Who Suffer From Chronic Hand Eczema, A Condition Characterized By Persistent Inflammation And Discomfort, A Important Advancement In Treatment Has Arrived. The Food And Drug Administration Recently Granted Approval To Delgocitinib, Offering A New Hope For Long-Term Relief Without The well-Documented Risks Associated with Conventional Corticosteroid Use.

The Burden Of Chronic Hand Eczema

Chronic Hand Eczema, Defined As Inflammation Lasting At Least Three Months Or Recurring Frequently, Can Profoundly Impact Daily Life. According To The National Eczema Association, Over 31.6 Million People In The United States Are Affected By Eczema, And While Not All Cases Manifest On The Hands, It Remains A Major Source Of Disability.

“If You Didn’t have Full Function Of Your Hands, Your Work, Productivity, Activities, School, And Leisure Activities Would All Be Affected,” Explains Raj Chovatiya, MD, PhD, MSCI, An Associate Professor at The Rosalind Franklin University Of Medicine And Science. “You Wouldn’t Be Able To Achieve Your Full Potential.”

The Limitations Of Traditional Treatments

Historically, Patients Have Depended On Long-Term corticosteroid Application To Manage Their Symptoms. While Effective For Short-Term Relief, Prolonged Use Carries The Risk Of Side Effects, Including Skin Thinning And Systemic Absorption. As The American Academy Of Dermatology Notes, Careful Monitoring Is Required when using Topical Corticosteroids For Extended Periods.

“Corticosteroids Are Great In The Acute Setting, But Challenging For A Long-Term Disease Like Chronic Hand Eczema,” Says Dr. Chovatiya. “The Cycle Of On-And-Off Usage Is Tough For Patients To Maintain.”

Delgocitinib: A New Approach

The Approval Of Delgocitinib (Anzupgo; LEO Pharma) Represents A Paradigm Shift In The Management Of Chronic Hand Eczema. This Steroid-Free Therapy Works Through A Novel Mechanism, Targeting The Root Causes Of Inflammation Without The Risks Associated With Traditional Treatments.

“This Approval Recognizes That Chronic Hand Eczema Is A Significant Condition Deserving Of Individual Attention,” States Dr. Chovatiya. “Patients Now Have A Rigorously Studied,Safe,And Effective Option.”

Feature	Topical Corticosteroids	Delgocitinib
Steroid-Based	Yes	No
Long-Term Use	Associated with risks	Designed for long-term use
Mechanism of Action	reduces inflammation broadly	Targets specific inflammation pathways
Potential Side Effects	Skin thinning, systemic absorption	Generally well-tolerated in trials

Did You Know? The prevalence of hand eczema has been steadily increasing in recent years, potentially linked to increased hygiene practices and exposure to irritants.

A Safer, more Effective Future

While Corticosteroids May Still Have A Role In Managing Acute Flare-ups, Delgocitinib offers A Viable Alternative For Patients Requiring Long-Term Control. Dr. Chovatiya Emphasizes “This Is Night And Day In Terms Of Our Treatment Approach.”

With A Proven Alternative Now Available, Individuals Living With Chronic hand Eczema Can Look Forward To A Future With Improved Comfort, Functionality, And Quality Of Life.

pro Tip: Regularly moisturizing your hands with a fragrance-free emollient can help manage symptoms and prevent flare-ups, even alongside medical treatments.

Understanding Hand Eczema

Hand eczema is a common skin condition that causes inflammation, dryness, and itching on the hands.It can range from mild discomfort to severe pain and disability. Factors such as genetics, environmental triggers (such as harsh soaps and detergents), and immune system dysfunction all contribute to the advancement of hand eczema. Early diagnosis and consistent treatment are key to managing the condition and preventing complications.

Frequently Asked Questions About Hand Eczema

• What is chronic hand eczema? Chronic hand eczema is a form of eczema that affects the hands and lasts for at least three months or recurs multiple times within a year.
• How is delgocitinib different from corticosteroids? Delgocitinib is a steroid-free therapy, reducing the risk of side effects associated with long-term corticosteroid use.
• What are the common triggers for hand eczema flare-ups? Common triggers include harsh soaps, detergents, chemicals, frequent hand washing, and cold weather.
• Is hand eczema contagious? No, hand eczema is not contagious and cannot be spread from person to person.
• What can I do at home to manage my hand eczema? Moisturizing frequently, avoiding irritants, and wearing gloves can help manage symptoms.
• Are there any lifestyle changes that can help prevent hand eczema? Identifying and avoiding personal triggers, managing stress, and maintaining a healthy diet can aid in prevention.

What are your thoughts on this breakthrough for sufferers of chronic hand eczema? Share your comments below and let’s discuss!

What are the potential systemic side effects associated with prolonged topical corticosteroid use for hand eczema?

The Limitations of Topical Steroids in Hand Eczema

For decades, topical corticosteroids have been the mainstay of treatment for hand eczema, also known as hand dermatitis. While effective for short-term flare-ups, prolonged adn frequent use can lead to notable side effects. These include skin thinning (atrophy), visible blood vessels (telangiectasia), and even systemic absorption with potential adrenal suppression. Patients with chronic hand eczema often find themselves in a cycle of steroid use, symptom relief, and subsequent rebound flares, creating a frustrating and often debilitating condition. The challenge lies in finding sustainable, long-term solutions that address the underlying inflammation without the risks associated with long-term steroid dependence.

Understanding the Pathophysiology of Chronic Hand Eczema

Effective treatment requires understanding what causes hand eczema. Its rarely a single factor. Key elements include:

* Genetic Predisposition: A family history of eczema, asthma, or allergies increases risk.

* Skin Barrier Dysfunction: Impaired skin barrier allows irritants and allergens to penetrate more easily. This is frequently enough linked to filaggrin gene mutations.

* Immune Dysregulation: An overactive immune response contributes to chronic inflammation. Specifically,the Th2 pathway is often implicated,but Th1 and Th17 pathways can also play a role.

* Environmental Factors: Exposure to irritants (soaps, detergents, chemicals), allergens (nickel, fragrances), and friction exacerbate symptoms.

* Occupational Exposure: Certain professions (healthcare, hairdressing, cleaning) carry a higher risk due to frequent hand washing and chemical exposure.

Emerging Therapies: Beyond Topical Corticosteroids

Dr. Raj Chovatiya, MD, PhD, MSCI, a leading dermatologist specializing in eczema, emphasizes a shift towards more targeted and innovative therapies. Here’s a breakdown of promising approaches:

1. Topical Calcineurin Inhibitors (TCIs) – Tacrolimus & Pimecrolimus

TCIs offer a steroid-sparing alternative. They work by suppressing the immune response locally, reducing inflammation without the same degree of skin atrophy risk.

* benefits: Effective for mild to moderate hand eczema, especially for maintenance therapy.

* Considerations: May cause a temporary burning sensation upon application.Long-term safety data continues to be evaluated.

2. Crisaborole (Eucrisa) – A PDE4 Inhibitor

Crisaborole is a non-steroidal topical ointment that inhibits phosphodiesterase 4 (PDE4), an enzyme involved in inflammation.

* Benefits: Well-tolerated, suitable for long-term use, and can be used on sensitive areas.

* Considerations: May not be as potent as TCIs or steroids for severe flares.

3. Biologic Therapies – Dupilumab (Dupixent)

Dupilumab is an injectable biologic that targets the IL-4 and IL-13 pathways, key drivers of type 2 inflammation. It’s approved for moderate-to-severe atopic dermatitis, and increasingly used off-label for severe chronic hand eczema unresponsive to other treatments.

* Benefits: Significant enhancement in itch, redness, and scaling.Can lead to long-term disease control.

* Considerations: Requires injections, potential for injection site reactions, and cost can be a barrier.

4. JAK Inhibitors – Topical and Systemic

Janus kinase (JAK) inhibitors block intracellular signaling pathways involved in inflammation.Topical ruxolitinib is approved for atopic dermatitis and shows promise for hand eczema. Systemic JAK inhibitors (oral medications) are also being investigated, but carry potential safety concerns and require careful monitoring.

* Benefits: Rapid symptom relief, potential for long-term control.

* Considerations: Topical JAK inhibitors can be expensive. Systemic JAK inhibitors have boxed warnings regarding serious infections and malignancy.

5. Barrier Repair Therapies & Emollients

While not a standalone treatment, robust skin barrier repair is essential for managing hand eczema.

* Ceramide-containing emollients: Help restore the skin’s natural lipid barrier.

* Occlusive agents (petrolatum, mineral oil): Create a protective barrier to prevent water loss.

* **Hum