Delgocitinib Approval Fills a Long-Standing Gap in Chronic Hand Eczema Treatment

Chronic hand eczema has long resisted clean diagnostic and therapeutic frameworks, sitting at the intersection of irritant contact dermatitis, allergic contact dermatitis, and atopic dermatitis in ways that rarely present in isolation. A new US Food & Drug Administration (FDA) approval is changing what clinicians can offer these patients, and Matthew Zirwas, MD, of Bexley Dermatology, described at Maui Derm NP+PA Summer 2026 in Colorado Springs why the arrival of topical JAK inhibition is a meaningful shift for this condition specifically.

In July 2025, the FDA approved delgocitinib cream for the treatment of adults with moderate to severe chronic hand eczema in whom topical corticosteroid use is not advisable, making it the first JAK inhibitor approved for this indication.2

4 Etiologic Categories, Rarely 1 Alone

Zirwas frames chronic hand eczema through 4 overlapping etiologic categories: pure irritant contact dermatitis, irritant plus allergic contact dermatitis, irritant plus atopic dermatitis, and all three combined. He said the last 2 categories are where diagnosis becomes genuinely difficult and where most treatment failures occur. Zirwas argued that pure allergic contact dermatitis or pure atopic dermatitis of the hands essentially does not exist in practice.

"I don't think there's anyone who has pure allergic contact dermatitis or pure atopic dermatitis of the hands," Zirwas said. "I think it's always 1 of those 2 plus irritant contact dermatitis, and that's because people wash their hands 4 or 5 times a day."

He drew an analogy to illustrate why this matters: if a patient with widespread dermatitis reported bathing 4 or 5 times daily, clinicians would immediately flag excessive washing as a driver of irritant dermatitis. Hand washing at that same frequency rarely prompts the same reflex, yet the mechanism is identical.

Why Topical Steroids Fall Short

Zirwas explained that topical corticosteroids address inflammatory symptoms but work against the underlying recovery process in irritant-driven hand eczema. Even short-term steroid use impairs barrier recovery, which is the primary mechanism by which irritant contact dermatitis resolves.

Other topical therapies that lack broad-spectrum anti-inflammatory activity fail on the symptom side. Zirwas said topical JAK inhibitors are the first class to address both without that tradeoff, providing broad-spectrum anti-inflammatory effects while leaving barrier recovery intact.

In the phase 3 DELTA 1 and DELTA 2 trials, delgocitinib achieved clear or almost clear skin in 20% to 29% of patients compared with 7% to 10% on vehicle, along with meaningful reductions in pain and itch, and long-term extension data showed durable responses and rapid recapture of disease control upon retreatment.2

A 3-Step Sequence for Hand Eczema

In practice, Zirwas follows a structured sequence. At the first visit, he takes a detailed history covering hand washing frequency, occupation, and glove use. He tells patients that, while gloves offer protection, they can magnify damage from residual soap, sweat, or chemicals through occlusion. He then initiates a high-potency topical steroid on a weekday-only schedule, Monday through Friday, and brings the patient back in a month.

If the patient has responded well and is using the steroid only minimally to maintain control, he continues that course. If the response was partial or the dermatitis rebounds whenever steroid use stops, he moves immediately to a topical JAK inhibitor.

"[For] those kind of people, I'm immediately going on to a topical JAK inhibitor," Zirwas said. "And then if the topical JAK inhibitor doesn't get them better, then I'm going on to patch testing."

The sequencing reflects the same logic he applies to systemic eczematous disease: reserve patch testing for cases where other interventions have failed to clarify the diagnosis, rather than leading with it.3

Editor’s note: Reported disclosures for Zirwas include GENZYME CORPORATION, Regeneron Healthcare Solutions, Dermavant Sciences, and more.

References

1. Zirwas M. Eczematous and Contact Dermatitis: Cases That Will Leave You Scratching Your Head. Session presented at Maui Derm NP+PA Summer 2026 in Colorado Springs on June 24.

2. Smith T. Delgocitinib Cream Available for Adults with Moderate-to-Severe Chronic Hand Eczema. HCPLive. Published on September 8, 2025. Accessed June 24, 2026. https://www.hcplive.com/view/delgocitinib-cream-available-adults-moderate-to-severe-chronic-hand-eczema

3. Zirwas M. IL-13 Inhibitor Response Can Guide Patch. HCPLive. Published on June 24, 2026. Accessed June 24, 2026. https://www.hcplive.com/view/il-13-inhibitor-response-guide-patch-testing-eczematous-dermatitis