Moving Beyond Steroids to a New Era in Chronic Hand Eczema Treatment: Raj Chovatiya, MD, PhD, MSCI

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Topical corticosteroids have long been a cornerstone of dermatologic care, including the management of chronic hand eczema, defined as hand eczema lasting at least 3 months or recurring twice or more within a year, which can significantly impact patients’ daily lives.

“You can imagine if you didn't have full function of your hands, your work, productivity, activities, school, leisure activities would probably all be affected,” said Raj Chovatiya, MD, PhD, MSCI, “and you wouldn't be able to be as successful as you theoretically could be in terms of the course of your life.” Chovatiya is an associate professor at the Rosalind Franklin University of Medicine and Science Chicago Medical School, and founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, Illinois.

Historically, he explained, patients have had to rely on long-term corticosteroid use to control symptoms, despite well-known risks associated with chronic application. “They're great to be used in the acute setting, and they're useful insofar as you might want to help somebody over the course of a few weeks with intermittent treatment,” Chovatiya noted, “but for a long-term disease like chronic hand eczema, [it’s] really challenging to be able to tell a patient to use this particular medication but use it for a couple of weeks, then take a couple of weeks off, then use it for a couple of weeks, and take a couple of weeks off.”

The July 23 approval of delgocitinib (Anzupgo; LEO Pharma), a steroid-free therapy with a novel mechanism of action, marks a pivotal shift in care. “The most significant implication of an approved therapy in this disease state is the fact that No. 1, chronic hand eczema is recognized as a burdensome disease worthy of individual regulatory approval. No. 2, the fact that patients now have something that's been rigorously studied and tested in patients that have chronic hand eczema. And [No.] 3, the product shows considerable efficacy and safety, which give it advantages over topical corticosteroids, which are really not meant to be used chronically given the risk of both cutaneous and systemic side effects.”

This development changes the treatment paradigm, he emphasized, adding that although corticosteroids may still have a role for short-term relief, “if [they’re] not enough to really help resolve the signs and symptoms of disease in the short term, I have a much safer and more effective long-term treatment in the case of topical delgocitinib. Really night and day in terms of our treatment approach.”

With a proven alternative now available, patients living with chronic hand eczema have a therapy that combines safety, efficacy, and durability—without the drawbacks of steroids.