ABCs in Dermatology: Rethinking Corticosteroid Stewardship in Chronic Hand Eczema

Chronic hand eczema (CHE), defined as hand eczema lasting more than 3 months or relapsing at least twice per year, affects roughly 1 in 10 adults in a given year, yet repeated cycling of topical corticosteroids (TCS) remains the default approach for many patients.1,2

In this episode of ABCs in Dermatology, hosts Lindsay Ackerman, MD, of US Dermatology Partners, and Chris Bunick, MD, PhD, of Yale School of Medicine, discussed corticosteroid stewardship and the evolving CHE treatment algorithm.

European guidelines recommend TCS as short-term first-line therapy, noting that potent agents can impair stratum corneum repair, cause skin atrophy, and interfere with long-term barrier recovery.2 Repeated application on fissured skin may also sensitize patients to corticosteroids themselves, making selective patch testing worthwhile when disease fails to respond. Systemic steroids carry their own burden: in a large US cohort, short courses of oral corticosteroids were associated with increased rates of sepsis, venous thromboembolism, and fracture.3

Both hosts described a decision point after roughly 3 to 4 weeks of high-potency TCS. Patients who have not reached clear or almost clear skin with little to no itch and pain warrant a different mechanism. The International Psoriasis Council recently defined topical failure in psoriasis as not achieving clear or nearly clear skin after 2 consecutive 4-week courses, a benchmark the hosts suggested could inform CHE practice.4

Delgocitinib cream 20 mg/g (Anzupgo), a topical pan-JAK inhibitor, is the only FDA-approved therapy for moderate to severe CHE in adults. In the phase 3 DELTA 1 and DELTA 2 trials, twice-daily application for 16 weeks achieved IGA-CHE treatment success in 20% and 29% of patients vs 10% and 7% with vehicle.5 Unlike other topical and oral JAK inhibitors, delgocitinib carries no boxed warning, and application-site reactions were reported in 1% or fewer of patients.

Head-to-head data extend the case. In DELTA FORCE, 513 adults with severe CHE received delgocitinib cream twice daily or oral alitretinoin 30 mg once daily. At week 12, delgocitinib produced a greater mean reduction in Hand Eczema Severity Index score (−67.6 vs −51.5) and higher IGA-CHE treatment success (27.2% vs 16.6%; P = .004), with fewer adverse events (49% vs 76%).6

Beyond pharmacotherapy, a detailed occupational and exposure history, barrier care with emollients and lukewarm water, and documentation of itch and pain on a 0-to-10 scale at each visit help guide escalation. Biologics and oral JAK inhibitors under investigation may further broaden options for severe disease.

Collectively, the discussion framed corticosteroid stewardship as recognizing when continued steroid cycling no longer serves the patient and moving to targeted therapy that can address skin, itch, and pain together.

References

1. Weisshaar E. Chronic hand eczema. Am J Clin Dermatol. 2024;25(6):909-926. doi:10.1007/s40257-024-00890-z

2. Thyssen JP, Schuttelaar MLA, Alfonso JH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis. 2022;86(5):357-378. doi:10.1111/cod.14035

3. Waljee AK, Rogers MAM, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. doi:10.1136/bmj.j1415

4. Strober BE, Blauvelt A, van de Kerkhof PCM, et al. Establishing consensus on defining failure of topical therapy in psoriasis: recommendations from the International Psoriasis Council. J Am Acad Dermatol. Published online September 28, 2025. doi:10.1016/j.jaad.2025.08.116

5. Bissonnette R, Warren RB, Pinter A, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double-blind, phase 3 trials. Lancet. 2024;404(10451):461-473. doi:10.1016/S0140-6736(24)01027-4

6. Giménez-Arnau AM, Pinter A, Sondermann W, et al. Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial. Lancet. 2025;405(10490):1676-1688. doi:10.1016/S0140-6736(25)00001-7