Raj Chovatiya, MD, PhD

CHE: Symptoms and Diagnosis

Video content above is prompted by the following: 

: Erythema, scaling, edema, vesicles, hyperkeratosis, fissures, and erosions, with more chronic than acute presentation.

: Distinguishing CHE from atopic dermatitis requires a holistic history and full-body examination.

: Beyond itching, skin pain represents a significant burden, particularly from fissures and cracking.

Dr Chovatiya emphasized that "from a patient perspective...a focus on skin pain as well as some of the cracking, bleeding, opening of skin, and wounding is going to be extraordinarily vital to really understanding the patient’s perspective."

Videos

An expert discusses how chronic hand eczema (CHE) diagnosis relies on clinical features such as erythema, scaling, vesicles, hyperkeratosis, fissures, and erosions, which must be distinguished from atopic dermatitis through a comprehensive patient history and full-body examination.

Risk Factors of CHE

: Occupational exposures, weather conditions, decreased indoor humidity, and tobacco use.

: Atopic dermatitis history, early onset of hand eczema, filaggrin mutations, and contact allergies.

: Highest risk industries include hairdressing, health care, food service, cleaning, and manufacturing, with CHE being the most common occupational skin disease.

Dr Chovatiya highlighted the difficulty in risk factor modification: "Even though sometimes we can do really good detective work...the actual implementation of changes to practically help people on a day-to-day basis can be very, very difficult."

An expert discusses how risk factors for chronic hand eczema (CHE) include atopic dermatitis, filaggrin mutations, contact allergies, environmental conditions, and occupational exposures, with hand eczema being the most common occupational skin disease.

Roflumilast is a therapeutic option for many patients with inflammatory conditions such as atopic dermatitis. It was 

approved by the US Food and Drug Administration (FDA)

 in 2024 as roflumilast cream 0.15% for individuals aged 6 years and older with moderate-to-severe atopic dermatitis.

 for roflumilast cream 0.05% was accepted by the FDA for mild to moderate atopic dermatitis in children aged 2 - 5 years old.

 To discuss the ways in which roflumilast could be addressing the unmet needs of patients with atopic dermatitis, the 

 team spoke with Raj Chovatiya, MD, PhD, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and the founder and director of the Center for Medical Dermatology and Immunology Research in Chicago.

Unmet Needs in Atopic Dermatitis and the Impact of Roflumilast Cream, with Raj Chovatiya, MD, PhD

“Roflumilast cream has been a bit of a jack of all trades in recent years, as roflumilast itself has now piled up a few different indications: psoriasis in its cream form, seborrheic dermatitis in its foam form, and a slightly different concentration in the cream form for atopic dermatitis,” Chovatiya explained. “That already highlights a really important unmet need.”

Chovatiya noted that dermatologists will often encounter situations, however, in which the issue facing a patient is not obvious and a combination of conditions could be present.

“Think about special sites like the hands, inverse folds, and genitals, or even the face and scalp regions,” Chovatiya said. “So that's already one important place where roflumilast has already found a home. Additionally, roflumilast is an extraordinarily well-tolerated, very gentle, primarily water-composed cream that really works for people with sensitive atopic dermatitis and eczematous skin.”

Consequently, Chovatiya highlighted his belief that roflumilast, as a therapeutic for the treatment armamentarium, provides a nice head-to-toe treatment option that addresses the signs and symptoms of the disease in patients.

“In some of the longer-term data, what it showed was that for individuals who were able to get totally clear, they were actually able to go towards more proactive use a few times a week and prevent new flares for a medium time of many, many months,” Chovatiya said. “So I think for patients that are willing to go to the point of being very diligent on daily use and getting to the point of being well controlled, they may have the chance just to intermittently use the cream and then to be great.”

For additional information on roflumilast’s use among patients with atopic dermatitis, view the full interview clip above.

The quotes used in this interview summary were edited for clarity. 

Chovatiya has reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc, Regeneron, RAPT, Sanofi, Sitryx, and UCB.

FDA Approves Arcutis’ ZORYVE® (roflumilast) Cream 0.15% for the Treatment of Atopic Dermatitis in Adults and Children Down to 6 Years of Age. Arcutis Biotherapeutics, Inc. June 9, 2024. 

https://www.globenewswire.com/en/news-release/2024/07/09/2910781/0/en/FDA-Approves-Arcutis-ZORYVE-roflumilast-Cream-0-15-for-the-Treatment-of-Atopic-Dermatitis-in-Adults-and-Children-Down-to-6-Years-of-Age.html

Arcutis Biotherapeutics. U.S. FDA accepts Supplemental New Drug Application For Arcutis’ ZORYVE® (roflumilast) cream 0.05% for the treatment of children aged 2 to 5 with mild to moderate atopic dermatitis. Arcutis Biotherapeutics. February 26, 2025. 

https://www.arcutis.com/u-s-fda-accepts-supplemental-new-drug-application-for-arcutis-zoryve-roflumilast-cream-0-05-for-the-treatment-of-children-aged-2-to-5-with-mild-to-moderate-atopic-dermatitis/

In this interview, Raj Chovatiya, MD, PhD, describes roflumilast cream's success in addressing unmet needs for atopic dermatitis.

An expert discusses how chronic hand eczema (CHE) presents in various clinical and etiologic subtypes, including irritant and allergic contact dermatitis, atopic hand eczema, and protein contact dermatitis, with clinical manifestations ranging from hyperkeratotic to vesicular forms.

CHE Subtypes

CHE Morphological and Etiological Subtypes

: Its 4 main categories are irritant contact dermatitis (most common), allergic contact dermatitis, atopic hand eczema, and protein contact dermatitis.

: Include hyperkeratotic, acute recurrent vesicular, nummular eczema, and pulpitis presentations, all with distinct characteristics.

: Most patients have mixed etiologies and clinical features rather than single, pure forms.

Dr Chovatiya noted that "etiologic subtypes don't predict specific clinical subtypes and clinical subtypes don't specifically predict etiologic subtypes," highlighting the complex presentation of CHE.

Raj Chovatiya, MD, PhD

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