Chronic Hand Eczema Linked to High Costs, Corticosteroid Overuse

Extensive corticosteroid dependence, highly fragmented treatment patterns, and health care costs that escalate sharply with disease intensity collectively define how moderate-to-severe chronic hand eczema (CHE) is managed in the United States, according to a new retrospective real-world claims analysis published in Dermatology and Therapy.¹

The results underscore the urgent need for disease-specific therapies, as there is only 1 FDA-approved therapy for moderate-to-severe CHE. The FDA approved delgocitinib cream (Anzupgo; LEO Pharma) in July 2025 for use in adults, and it is currently under review with the FDA for use in children aged 12 to 17 years.^2,3

“Beyond its physical symptoms, CHE has a profound impact on quality of life, emotional well‑being, and work productivity, often limiting patients’ ability to perform routine daily tasks,” the authors explained.¹

Real-World CHE Treatment Patterns

Researchers analyzed US insurance claims data spanning January 2016 through April 2024 from the Komodo Research Data database, which covers more than 170 million patients across more than 150 commercial, Medicaid, and Medicare payers. The final study sample included 6295 adults with moderate-to-severe CHE, with a mean age of 48.2 years; 63.8% were female, 65.0% were White, and 76.6% were commercially insured.

Over an average follow-up of 3.5 years, systemic and topical corticosteroids were the dominant treatment approaches, used by 86.2% and 81.3% of patients, respectively. By contrast, only 4.3% received immunosuppressants, 3.5% of patients received monoclonal antibodies, and just 0.3% were prescribed oral Janus kinase (JAK) inhibitors. Phototherapy was used by only 1% of the cohort.

The extensive reliance on corticosteroids is particularly concerning, the authors noted, given “despite the well‑documented risks associated with prolonged exposure,” including hypertension, adrenal suppression, myocardial infarction, cataracts, fractures, and behavioral changes. The International Eczema Council has previously stated that systemic corticosteroids should be reserved for acute flares rather than used as a maintenance strategy.⁴

Treatment patterns were strikingly heterogeneous, with patients frequently cycling between systemic therapies, topical-only approaches, and periods of no treatment at all. The authors suggested the treatment pattern reflects the challenge of managing the multifactorial nature of CHE, the lack of disease-specific US treatment guidelines during the study period, and the limited availability of well-tolerated options prior to the FDA's approval of delgocitinib.

How Costs Climbed With Treatment Intensity

The economic findings were stark. Among patients stratified by treatment intensity, eczema/dermatitis-related health care costs rose dramatically as therapies escalated. Patients with at least 2 claims for any systemic therapy (cohort 1) incurred mean total costs of $1876 per patient per year (PPPY). That figure rose to $9505 PPPY for those receiving noncorticosteroid systemic agents such as immunosuppressants or retinoids (cohort 2) and reached $21,682 PPPY for patients treated with monoclonal antibodies or oral JAK inhibitors (cohort 3). Pharmacy costs drove the bulk of total spending across all cohorts, accounting for $1221 PPPY in cohort 1, $8898 in cohort 2, and $20,760 PPPY in cohort 3.¹

The cost trajectory observed in CHE mirrors findings documented in broader atopic dermatitis (AD) research. A different US claims analysis of adults with AD found that pharmacy costs were the primary driver of disease-attributable spending and that costs increased substantially with baseline severity, ranging from $379 PPPY in patients with clear to mild disease to $9744 PPPY in those with severe disease.⁵

Disease Complexity Compounded Management Challenges

The CHE study also highlighted the substantial clinical heterogeneity embedded within the CHE population. Nearly half of patients (45%) were classified as having multiple eczema/dermatitis subtypes simultaneously, and that proportion rose with treatment intensity, reaching 91.6% among patients being treated with monoclonal antibodies or oral JAK inhibitors.¹

The overlap of subtypes is consistent with what clinicians have described in practice. Dermatologist Raj Chovatiya, MD, PhD, MSCI, told The American Journal of Managed Care^® that CHE is challenging to manage precisely because most patients present with multiple overlapping etiologies.⁶

“Oftentimes there's some component of atopic dermatitis, some component of irritant contact dermatitis, maybe even some component of allergic contact dermatitis as well,” he said. “While it's sometimes challenging to maybe look for a singular cause, because there often isn't a singular cause, it's not so difficult to make the diagnosis, as the only criteria you're really looking for are CHE that occurs for at least 3 months or has 2 instances of flare over the course of a year.”

That complexity is compounded by the historical absence of a CHE-specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code, which has made it difficult to systematically track or study this patient population in administrative data, the authors noted. The current analysis addressed that limitation by using Systematized Nomenclature of Medicine–Clinical Terminology (SNOMED CT) codes in combination with eczema/dermatitis ICD-10-CM codes to identify the study cohort.¹

Comorbid mental health burden also warrants attention since depression and anxiety affected 16.2% and 21.0% of patients in the overall sample, respectively. These comorbidities carry meaningful psychosocial costs that extend beyond the skin.

What This Means for Managed Care Stakeholders

The study was conducted entirely during a period when no CHE-specific therapy had received FDA approval, which the authors noted is a critical contextual factor. The FDA's July 2025 approval of delgocitinib, a topical pan-JAK inhibitor, as the first and only treatment specifically labeled for moderate-to-severe CHE in adults with an inadequate response to topical corticosteroids, represents a potentially meaningful pivotal change.²

The study's authors call for future research, including patient chart reviews, to examine how treatment patterns shift in the post-approval era.¹

“Taken together, these findings underscore the urgent need for well‑tolerated, disease‑specific treatments that can reduce reliance on corticosteroids, limit costly therapeutic escalation, and improve long‑term disease control for patients with CHE,” the authors wrote.

The study was funded by LEO Pharma Inc, the maker of delgocitinib. Several authors are employees of LEO Pharma or of Analysis Group, a consulting firm that received payment from LEO Pharma for the study's development and conduct.

References

1. Armstrong AW, Burne R, Bin Sawad A, et al. Treatment patterns and economic burden in moderate to severe chronic hand eczema in the USA: a real-world retrospective claims analysis. Dermatol Ther (Heidelb). Published online April 24, 2026. doi:10.1007/s13555-026-01755-5
2. Shaw ML. FDA approves delgocitinib for moderate to severe hand eczema. AJMC^®. July 24, 2025. Accessed May 20, 2026. https://www.ajmc.com/view/fda-approves-delgocitinib-for-moderate-to-severe-hand-eczema
3. LEO Pharma announces FDA acceptance of supplemental NDA for Anzupgo (delgocitinib) cream for the treatment of chronic hand eczema in children aged 12-17. News release. LEO Pharma. April 15, 2026. Accessed May 20, 2026. https://www.leo-pharma.com/media-center/news/2026-acceptance-of-anzupgo-snda
4. Drucker AM, Eyerich K, de Bruin‐Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018;178(3):768-75. doi:10.1111/bjd.15928
5. Gavidia M. Substantial cost burden, health care utilization found in patients with severe atopic dermatitis. AJMC. January 21, 2022. Accessed May 20, 2026. https://www.ajmc.com/view/substantial-cost-burden-health-care-utilization-found-in-patients-with-severe-atopic-dermatitis
6. Shaw ML, Chovatiya R. Delgocitinib is redefining chronic hand eczema treatment: a Q&A with Raj Chovatiya, MD, PhD, MSCI. AJMC. November 10, 2025. Accessed May 20, 2026. https://www.ajmc.com/view/delgocitinib-is-redefining-chronic-hand-eczema-treatment-a-q-a-with-raj-chovatiya-md-phd-msci