Chronic Hand Eczema: Pathways and Emerging Therapies
Clinical Summary
Chronic Hand Eczema (CHE): Immune Phenotypes and Emerging Targeted Therapies
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CHE phenotypes: Chronic hand eczema is not a single disease; clinical management should differentiate atopic dermatitis–associated CHE, irritant contact dermatitis, and allergic contact dermatitis, as pathophysiology and treatment response vary.
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Inflammatory pathways: Atopic dermatitis–associated CHE involves TH2/TH22, irritant contact dermatitis involves TH1/TH17, and allergic contact dermatitis varies by allergen (e.g., metals: TH1/TH17; fragrance/rubber: TH2/TH22).
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Targeted therapies: Delgocitinib (topical JAK inhibitor) offers a non-steroidal long-term treatment option; emerging oral agents and biologics may benefit patients with recalcitrant CHE requiring systemic therapy.
Reviewed by Riya Gandhi, MA, Associate Editor of Immunology Group
Dr Emma Guttman explains how chronic hand eczema (CHE) is now understood as a heterogeneous disease driven by different immune pathways—including TH1, TH2, TH17, and TH22—depending on underlying causes such as atopic dermatitis, irritant contact dermatitis, or allergic contact dermatitis. Learn how this evolving understanding is shaping personalized treatment strategies and how emerging options, including topical JAK inhibitors like delgocitinib and systemic targeted therapies, may transform care for patients with difficult-to-manage CHE.
Transcript
Hi, I'm Emma Guttman. I come from New York City where I'm the chair of the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.
How has our evolving understanding of the pathophysiology of chronic hand eczema changed the way we think about its clinical phenotypes and management?
Dr Guttman: Yeah, so chronic hand eczema used to be thought as one phenotype. It's not one phenotype. It matters whether you have atopic dermatitis or you do not have atopic dermatitis, whether you have irritant contact dermatitis, you have allergic contact dermatitis and what's the allergen and so on. So we cannot really treat it as one size fits all. And it will depend. If it's a JAK inhibitor, probably we can treat similarly across all of these, but if it's a TH2 targeting agent, we need to think what type of chronic and eczema is ahead of us.
What emerging inflammatory pathways or disease mechanisms in CHE are most relevant to therapeutic decision making today?
Dr Guttman: So if the patient has atopic dermatitis, the patient obviously has TH2 and TH22. If the patient has irritant contact dermatitis, it's TH1 and TH17. And if it's allergic contact dermatitis, if it's metals, it's TH1, TH17. And if it's fragrance and rubber, for example, it's TH2 and TH22.
Looking ahead, how might targeted therapies reshape the treatment landscape for patients with recalcitrant or difficult to manage CHE?
Dr Guttman: So first of all, we'll get an approved treatment. We already have one that are not tainting the skin. So we now have Delgocitinib, a JAK inhibitor that is not a steroid, so can be applied long term. And now we start having some orals or biologics that are needed for some patients with more recalcitrant disease long term.
