Navigating Complexities and Unmet Needs of Chronic Hand Eczema

“Chronic hand eczema is defined as hand eczema that occurs for more than 3 months in a year, or relapses twice or more in a given year. Another way to think about chronic hand eczema is that it is a heterogeneous, long-lasting, fluctuating inflammatory skin disease of the hands,” said Christopher Bunick, MD, PhD, in a recent interview with Dermatology Times.

Bunick, associate professor of dermatology and translational biomedicine at the Yale University School of Medicine in New Haven, Connecticut, and Dermatology Times’ 2024 Winter Editor in Chief discussed chronic hand eczema’s (CHE) significant impact on quality of life in patients, the key differences between CHE and atopic dermatitis on the hand, and the lack of FDA-approved treatments in the US.

As the US market awaits the approval of delgocitinib (LEO Pharma) for moderate to severe CHE, the European Commission granted marketing authorization for the topical treatment in the European Union and select European countries. Delgocitinib is a topical pan-JAK inhibitor that inhibits the activation of JAK-STAT signaling.¹

Clinical Pearls

1) Heterogeneity and Clinical Presentation: CHE is defined as eczema lasting more than 3 months or recurring twice or more within a year. Its heterogeneous nature is due to varying clinical presentations and morphologies. According to Bunick, a key challenge is that more than 50% of patients may have multiple clinical or etiologic subtypes simultaneously, including atopic and non-atopic dermatitis forms. CHE can fluctuate in severity over time, with symptoms such as itching, pain, fissuring, erythema, and thickened, cracked skin. This variability complicates diagnosis and emphasizes the need for a personalized, subtype-specific approach to management.

2) Quality of Life and Comorbidities: CHE significantly impacts a patient's quality of life and can be comparable to or worse than other serious chronic diseases, according to Bunick. CHE’s visual prominence, as hands are highly visible in daily life, contributes to its psychosocial burden. Patients experience high socioeconomic impacts, including job loss, decreased productivity, and difficulty performing domestic tasks due to exposure to irritants such as handwashing or household chemicals. Psychiatric comorbidities such as depression, anxiety, and suicidal ideation are also common, highlighting the need to address the mental health impact of CHE on patients.

3) Therapeutic Challenges and Unmet Needs: Currently, there are no FDA-approved treatments for moderate to severe CHE in the US. The long-term use of topical corticosteroids can lead to adverse effects such as skin atrophy and rebound flares. Additionally, corticosteroid phobia and poor compliance are common issues, according to Bunick. Calcineurin inhibitors offer a steroid-sparing option for atopic subtypes, as most patients express a preference for steroid-free treatments. There is a high unmet need for non-steroidal, well-tolerated topical treatments that can manage the diverse immune pathways and subtypes of CHE to improve long-term control and patient adherence.

Reference

1. European Commission approves LEO Pharma’s Anzupgo (delgocitinib) cream for adults with moderate to severe chronic hand eczema (CHE). News release. LEO Pharma. September 23, 2024. Accessed October 23, 2024. https://www.leo-pharma.com/media-center/news/2024-european-commission-approves-leo-pharma-anzupgo#:~:text=BALLERUP%2C%20Denmark%2C%20September%2023%2C,eczema%20(CHE)%20for%20whom%20topical