Chronic Hand Eczema: Treatment Gaps, New Options, and Clinical Trial End Points

“Having new topicals, orals, and biologics to help with chronic hand eczema is something that we need, and I’m optimistic we'll get more agents in the future that address that need,” said David Rosmarin, MD, in an interview at the 2026 Revolutionizing Atopic Dermatitis Conference in Nashville, Tennessee.

Rosmarin, a dermatologist and chair of the department of dermatology at Indiana University School of Medicine, presented his insights into chronic hand eczema (CHE) care during the session, “Late-Stage AD Pipeline Review, Clinical Updates in CHE,” alongside Killian Eyerich, MD, PhD; Andrea Bauer, MD; and Jeff Yu, MD, MS.¹ Rosmarin addressed the growing pipeline of agents, the distinct challenges of CHE, and how he approaches both clinical data and individualized patient care.

Emerging Agents in the Pipeline

Rosmarin highlighted several pipeline agents for atopic dermatitis and CHE that he finds notable across multiple mechanisms of action. He pointed to STAT6 inhibitors, including Kymera Therapeutics’ KT-621 and Recludix’s REX-8756, as well as Corvus Pharmaceuticals’ ITK inhibitor, soquelitinib. The longer-acting IL-13 agent zumilokibart (Apogee Therapeutics) also drew his attention, along with bispecific approaches targeting IL-18 combined with IL-13 and combinations of IL-13, IL-4, TSLP, or IL-4 receptor with TSLP.

One mechanism he described as particularly novel is the IL-2 agonist rezpegaldesleukin (Nektar Therapeutics), which works by increasing regulatory T cells to modulate the immune response in atopic dermatitis. "The fact that it can increase the breaks on the immune system, the T regs, and treat atopic dermatitis is also very exciting," Rosmarin said.

Why CHE Requires Dedicated Treatments

Rosmarin described CHE as a condition with a distinctive and often underappreciated disease burden. Because hands are used constantly and exposed to chemicals and irritants, the condition frequently involves components beyond atopic etiology, including irritant and allergic contact contributions.

"When people have hand involvement of their eczema, it really affects them," Rosmarin said. "It can be extremely painful and affect people in terms of their quality of life in a much more severe way than if other areas are affected."

He also noted the barrier to topical efficacy: skin on the hands tends to be thicker, making penetration more difficult and creating an even greater need for systemic and biologic options specific to this population.

Evaluating Clinical Trial Data Across End Points

When reviewing trial results, Rosmarin emphasized looking for consistency across multiple end points rather than anchoring to any single measure. He prioritizes the EASI score, particularly EASI 75 and EASI 90, alongside Pruritus NRS and the FDA-mandated endpoint of IGA 0 or 1.

"I'm not just looking for one end point, but I want to see consistency across multiple endpoints," Rosmarin said.

Individualized Care and Shared Decision-Making

In practice, Rosmarin said he segments patients by whether they are topical responders or require a systemic agent, noting some patients benefit from a systemic therapy plus a topical used on a PRN basis. He emphasized shared decision-making as a core part of his approach.

For topical responders, delgocitinib (Anzupgo; LEO Pharma) was first FDA-approved for adults with moderate to severe CHE in July 2025, and served as the first major step toward providing patients with CHE the first disease-specific topical.²

Overall, he expressed confidence in finding effective regimens even for patients with recalcitrant disease, given the expanding range of available options.

References

1. Rosmarin D, Eyerich K, Bauer A, Yu J. Late-stage AD pipeline review, clinical updates in CHE. Presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN
2. Anzupgo (delgocitinib) cream is now the first and only FDA-approved treatment for moderate-to-severe chronic hand eczema (CHE) in adults. News release. LEO Pharma Inc. July 23, 2025. Accessed June 18 2026. https://www.businesswire.com/news/home/20250723115252/en/ANZUPGO-delgocitinib-Cream-Is-Now-the-First-and-Only-FDA-Approved-Treatment-for-Moderate-to-Severe-Chronic-Hand-Eczema-CHE-in-Adults