David Rosmarin, MD, on CHE Heterogeneity and Unmet Needs in AD and Vitiligo

“Having multiple treatments and trying to figure out which treatments would be best in which [chronic hand eczema] phenotype is something I'm hoping will evolve with further research,” 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 In his first interview, Rosmarin reviewed the growing pipeline of atopic dermatitis (AD) and CHE agents, the distinct challenges of CHE, and how he approaches both clinical data and individualized patient care.

Next, Rosmarin addressed the phenotypic diversity of CHE, areas of continuing unmet need in AD, and what he is watching in the vitiligo pipeline.

Heterogeneity in CHE

Rosmarin described patients with CHE as a particularly varied population, encompassing atopic, allergic contact, irritant contact, and mixed etiologies. This heterogeneity complicates treatment selection and underscores the need for more options matched to specific phenotypes.

"They're not all the same phenotype, they're a pretty heterogeneous group," Rosmarin said. "Some people have hand eczema due to atopic disease, some have it due to allergic disease, some irritant, and many are a combination of those factors."

He noted patients with CHE can be highly recalcitrant to treatment, reinforcing the need for continued research into which therapies are best suited to which patient presentations.

Unmet Needs in the AD Pipeline

Rosmarin outlined 3 primary areas of unmet need he is watching in AD. The first is an oral agent with a clean label—territory he believes STAT6 inhibitors and potentially an ITK inhibitor could address. The second is biologics with less frequent dosing to improve convenience and adherence. The third is new mechanisms for patients in whom current IL-4, IL-13, JAK inhibitors, and anti-IL-31 may fall short.

"Even though we have 3 treatments in IL-4 and IL-13, JAK inhibitors, and anti-IL-31s, we're always looking for new mechanisms when those options fail," Rosmarin said.

He also highlighted bispecific and trispecific agents in development as a potential avenue for pushing efficacy beyond current limits. "Can we push the efficacy limits we currently have with our options right now? So, there's a lot to be excited about," Rosmarin said.

The Vitiligo Pipeline and Emerging Systemic Options

Rosmarin noted ruxolitinib cream (Opzelura; Incyte), approved in July 2022, remains the only FDA-approved treatment for vitiligo, with label restrictions to 10% or less body surface area.² He described systemic agents as a critical unmet need for patients with more active disease, larger affected surface areas, or those unable to use a topical consistently.

3 JAK inhibitors are currently in late-stage development for vitiligo: upadacitinib (Rinvoq; AbbVie), povorcitinib (Incyte), and ritlecitinib (Litfulo; Pfizer), and Rosmarin expressed confidence in the prospects for all 3. "I'm optimistic all 3 will ultimately get approved," he said.

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. Incyte announces U.S. FDA approval of Opzelura (ruxolitinib) cream for the treatment of vitiligo. News release. Incyte. July 18, 2022. Accessed June 18, 2026. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-us-fda-approval-opzeluratm-ruxolitinib-cream-0