Network Meta-Analysis Identifies Most Effective CHE Therapy

Chronic hand eczema (CHE) remains one of dermatology’s most burdensome inflammatory conditions, both for patients and clinicians seeking durable symptom control. Affecting an estimated 10% of the global population and frequently leading to occupational impairment, CHE is notoriously difficult to treat due to its heterogeneous etiologies, environmental triggers, and chronic relapsing course.¹ The recently published network meta-analysis (NMA) offers the first quantitative comparison of modern CHE monotherapies using standardized HECSI outcomes, representing a significant step forward in evidence synthesis.²

Study Design and Methods

The authors conducted a systematic review and NMA following PRISMA-NMA standards. The analysis incorporated 5 randomized trials comprising 10 active monotherapies, including both FDA/EMA-approved treatments (alitretinoin and delgocitinib) and emerging topical JAK inhibitors such as ARQ-252. Eligible trials assessed monotherapy-based changes in Hand Eczema Severity Index (HECSI) scores at 12 or 16 weeks.

The authors highlight that eligible studies needed to evaluate “the impact of monotherapies on CHE insofar as the mean change in HECSI scores between 12 and 16 weeks from baseline," a methodological decision that excluded many prior eczema trials due to inconsistent outcome measures. This point is clinically important: HECSI remains one of the most validated tools for quantifying objective severity in hand eczema.

Key Findings

Across all networks and sensitivity analyses, the authors report that, “delgocitinib 8 mg/g twice daily (topical) was ranked the most efficacious—in both the base and sensitivity analyses."

This formulation significantly outperformed oral alitretinoin, a long-established systemic therapy for severe CHE, at both 12 and 16 weeks. The magnitude of benefit was clinically meaningful; for example, at 12 weeks it improved HECSI scores by roughly 25 points more than alitretinoin (MD=24.65; 95% CI: 9.05–40.07). This finding aligns with the growing recognition that targeted topical JAK inhibition may achieve rapid anti-inflammatory effects without the systemic risks associated with retinoids or phototherapy.

Dupilumab, while showing promise in smaller trials, demonstrated significant superiority over alitretinoin only in the unadjusted 16-week analysis; sex- and age-adjustments attenuated these effects, likely reflecting the small sample size of the dupilumab arm (N=20).

ARQ-252 (topical JAK1 inhibitor) delivered moderate but less consistent improvements, and no ARQ-252 regimen surpassed delgocitinib in any comparative scenario.

Clinical Implications

This study holds several important implications for dermatology practice:

• A new hierarchy of efficacy is emerging.
  Delgocitinib at higher concentrations appears to be the most effective monotherapy currently studied for 12–16-week HECSI reduction, suggesting that topical pan-JAK inhibition may soon shift first-line therapy paradigms for moderate to severe CHE.
• Systemic therapy may not always be necessary.
  The finding that a topical therapy outperformed oral alitretinoin challenges long-held assumptions about the need for systemic agents in severe cases.
• Validated outcome measures matter.
  The authors note that past reviews were limited because “the stark heterogeneity in choice of outcome measures and timepoints… precluded meaningful quantitative syntheses.” By focusing on HECSI, the present NMA provides a more reliable comparative framework.
• Sex- and age-adjusted data provide enhanced clinical relevance.
  Given CHE’s differential burden across demographics, such sensitivity analyses strengthen real-world applicability of the findings.

Conclusion

This network meta-analysis represents the first rigorous quantitative comparison of modern monotherapies for CHE using standardized endpoints. Its central finding—that delgocitinib 8 mg/g twice daily is currently the most efficacious option among studied treatments—has direct implications for clinical decision-making, patient counseling, and treatment algorithms.

While long-term safety, relapse rates, and cost-effectiveness remain to be elucidated, this work provides dermatologists with a clearer evidence-based hierarchy of available therapies and supports the continued integration of targeted topical JAK inhibitors into CHE management.

References

1. Balato A, Tancredi V, Aerts O, et al. Chronic hand eczema: Common questions and practical recommendations from the EADV Contact Dermatitis Task Force. J Eur Acad Dermatol Venereol. Published online September 29, 2025. doi:10.1111/jdv.70068

2. Gupta AK, Bamimore MA, Talukder M. Comparative efficacy of monotherapies for chronic hand eczema: A network meta-analysis study. J Cosmet Dermatol. 2025;24(12):e70552. doi:10.1111/jocd.70552