Getting the Upper Hand on CHE! Observations from a Principal Investigator

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes April Armstrong, MD, MPH, Professor and Chief of Dermatology at UCLA, to discuss chronic hand eczema (CHE) and the introduction of the first FDA-approved treatment developed specifically for this condition. The conversation begins with a review of CHE as a distinct clinical entity, highlighting its subtypes: irritant contact dermatitis, allergic contact dermatitis, atopic hand eczema, and the less common protein contact dermatitis. They highlight occupational exposures and daily “wet work” that increase risk, while Dr Del Rosso notes the challenge of overlapping subtypes in real-world patients. Practical considerations, such as glove selection and improving patient adherence, are also addressed. The discussion then turns to delgocitinib cream, the newly approved topical pan–JAK inhibitor for moderate-to-severe CHE. Dr Armstrong explains its mechanism of action, which targets the JAK-STAT pathway across multiple immune processes involved in different CHE subtypes. They note the significance of its approval without a boxed warning, contrasting it with other topical JAK inhibitors and providing context on evolving perspectives on JAK inhibitor safety. Clinical trial findings are discussed in detail, including meaningful improvements in itch, pain, and quality of life, along with the durability of response over time. Importantly, efficacy was observed across CHE subtypes, reflecting the drug’s utility across real-world patient heterogeneity. Adverse events were minimal, with no systemic safety signals observed. Tune in to the full episode to hear Dr Armstrong and Dr Del Rosso highlight the key factors of diagnosing and treating CHE, the clinical impact of delgocitinib, and how dermatologists are now better positioned to treat this commonly encountered yet difficult to manage condition.