CHE Talk at Fall Clinical Highlights Precision Therapies
With new FDA approvals, investigational therapies nearing the finish line, and a greater understanding of disease heterogeneity, chronic hand eczema (CHE) is increasingly viewed as a condition requiring individualized, mechanistically informed care, Alexandra Golant, MD, and Benjamin Ehst, MD, PhD, emphasized during a talk at the 2025 Fall Clinical Dermatology Conference.
CHE is not a single entity but rather a heterogeneous group of eczematous conditions involving multiple overlapping etiologies, including irritant contact, allergic contact, and atopic dermatitis, Dr. Ehst noted. In a national survey of nearly 1,000 patients with CHE, the majority reported being told they had more than one subtype, aligning with clinical observations that mixed forms are common.
“I like to think of it as an everything bagel,” Dr. Golant said, humorously illustrating the layered complexity. “A little bit of poppy seed, sesame, and salt; more than one thing is usually contributing.”
Accurate classification remains important to guide treatment, particularly in patients with occupational exposures or recalcitrant disease. Diagnostic tools include history taking (occupational, atopic background, irritant exposures); skin scraping or KOH prep to rule out infection; fungal culture, especially in tinea-manualis–like presentations; patch testing when allergic contact dermatitis is suspected; and biopsy, though that often can be nonspecific or misleading in chronic disease.
Dr. Golant noted the importance of examining other sites, such as the feet or nails, to identify patterns that may support an atopic or contact component.
THERAPEUTIC ADVANCES
The recent approval of a topical JAK inhibitor, delgocitinib 0.5% ointment, for moderate-to-severe CHE was a major milestone. Dr. Ehst showed data from the DELTA 1 and DELTA 2 trials demonstrating rapid and significant improvement in treatment success rates at 16 weeks compared to vehicle. Patients saw early symptomatic relief and functional gains, with visible results by week 2 in some cases. Treatment success was defined as clear or almost clear with ≥2-point improvement on IGA. Symptom improvement was defined as rapid onset of relief in pain, itching, and hand function.
Dr. Golant underscored the importance of targeting quality of life for improvement in CHE.
“Hands are how we interact with the world,” Dr. Golant said. “Treatment success must restore function.”
Ruxolitinib 1.5% cream, FDA-approved for atopic dermatitis, also demonstrated promise in phase 2 CHE trials. By Week 16, 53% of patients achieved IGA treatment success, with sustained responses through Week 32. Early improvement by Week 2 also supports its role as a rapid-acting option for patients with inflammatory features and fingertip involvement.
For patients with more extensive or recalcitrant CHE, systemic therapy may be indicated—especially when topical options fail or when underlying atopic dermatitis plays a role. Dupilumab has demonstrated efficacy in CHE with atopic features; Dr. Golant and Dr. Ehst showed one patient case in which nail dystrophy due to palmar eczema resolved within 6 months of treatment. Tralokinumab also showed treatment success (~40% at Week 16) in patients with atopic CHE in trials, with improvements in IGA and symptom scales.
Dr. Ehst noted that while CHE may involve lower BSA, the functional impact is often high enough to justify systemic intervention.
“These patients can have just 5% BSA involved,” he said, “but it’s disabling.”
A final case revisited an airplane mechanic with longstanding CHE refractory to moisturizers, topical steroids, and barrier avoidance. Ultimately, combination therapy and reduced handwashing improved control. Dr. Golant emphasized this as a perfect example of a “classic combo” patient for whom mixed etiology required both precision topicals and systemic consideration.
“With so many new tools,” Dr. Golant said, “this is truly a wonderful time to be treating CHE. We can move quickly and precisely toward real relief.”