New Agents Aim to Close Gaps in Chronic Hand Eczema Care

Although chronic hand eczema (CHE) still lacks enough treatment options, David Rosmarin, MD, chair of the department of dermatology at Indiana University School of Medicine, is optimistic that new topicals, orals, and biologics will emerge to fill the gap even as clinicians face the ongoing challenge of matching whatever mechanisms arrive to the right patient phenotype. Rosmarin discussed the CHE and atopic dermatitis (AD) pipelines with Dermatology Times^®,^1,2 a sister publication of The American Journal of Managed Care^®, at the 2026 Revolutionizing Atopic Dermatitis Conference, held June 17-19 in Nashville, Tennessee.

Rosmarin presented on the topic during a session titled "Late-Stage AD Pipeline Review, Clinical Updates in CHE," alongside Killian Eyerich, MD, PhD; Andrea Bauer, MD; and Jeff Yu, MD, MS.³ His comments come as research has demonstrated the substantial clinical and economic toll of CHE, including a recent claims analysis showing heavy reliance on corticosteroids and fragmented treatment patterns among patients with the condition.⁴

What New Mechanisms Are in the CHE and AD Pipeline?

Rosmarin pointed to several agents across multiple mechanisms of action that he considers notable for AD and CHE. These include STAT6 inhibitors such as KT-621 (Kymera Therapeutics) and REX-8756 (Recludix), along with the interleukin (IL)-2–inducible T-cell kinase (ITK) inhibitor soquelitinib (Corvus Pharmaceuticals). He also highlighted the longer-acting IL-13 agent zumilokibart (Apogee Therapeutics) and bispecific approaches pairing IL-18 with IL-13 or combining IL-13, IL-4, thymic stromal lymphopoietin (TSLP), or the IL-4 receptor with TSLP.

Among the most novel mechanisms in development is rezpegaldesleukin (Nektar Therapeutics), an IL-2 agonist that works by expanding regulatory T cells to modulate immune activity in AD. Rosmarin called the ability to boost the body's own regulatory response while treating disease "very exciting."

Why Does CHE Need Its Own Treatments?

Unlike AD affecting other body areas, CHE carries a disproportionate burden because hands are in constant use and exposed to chemicals and irritants, Rosmarin explained, meaning the condition often involves irritant and allergic contact contributions layered on top of atopic disease. He noted that hand involvement can be more painful and more disruptive to quality of life than eczema elsewhere on the body and that the thicker skin on the hands limits how well topical therapies penetrate, which reinforces the need for systemic and biologic options tailored to this population.

Approved by the FDA in July 2025 for adults with moderate to severe CHE, delgocitinib (Anzupgo; LEO Pharma) marked the first disease-specific topical therapy for the condition and remains a first-line option for patients who respond to topical treatment.⁵ Trial data have shown delgocitinib produces rapid improvements in itch and clearance with a favorable safety profile.⁶

How Should Clinicians Weigh Trial End Points?

When evaluating new therapies, Rosmarin said he looks for consistency across multiple end points rather than relying on a single measure, prioritizing Eczema Area and Severity Index (EASI) scores—particularly EASI 75 and EASI 90—alongside the Pruritus Numeric Rating Scale and the FDA-mandated Investigator's Global Assessment of 0 or 1. In practice, he segments patients by whether they respond to topical treatment or require systemic therapy, sometimes combining a systemic agent with an as-needed topical, and he emphasized shared decision-making as central to his approach.

What Gaps Remain in Treating CHE and AD?

Rosmarin described CHE as a heterogeneous condition spanning atopic, allergic contact, irritant, and mixed etiologies, which complicates matching patients to the right therapy. He said he hopes further research will clarify which treatments work best for which phenotype, particularly for patients whose disease proves difficult to control.

For AD more broadly, Rosmarin outlined 3 areas of unmet need: an oral agent with a "clean label," territory he believes STAT6 and ITK inhibitors could address; biologics with less frequent dosing to improve convenience and adherence; and new mechanisms for patients whose disease does not respond to existing IL-4, IL-13, Janus kinase (JAK), or anti–IL-31 therapies. Bispecific and trispecific agents in development, he said, could help push efficacy beyond current limits.

As the CHE and AD pipelines expand, Rosmarin said the next challenge is figuring out which of these emerging options work best for which patients.

References

1. Rosmarin D, Bader K. Chronic hand eczema: treatment gaps, new options, and clinical trial end points. Dermatology Times. June 18, 2026. Accessed July 14, 2026. https://www.dermatologytimes.com/view/chronic-hand-eczema-treatment-gaps-new-options-and-clinical-trial-end-points
2. David Rosmarin, MD, on CHE heterogeneity and unmet needs in AD and vitiligo. Dermatology Times. June 19, 2026. Accessed July 14, 2026. https://www.dermatologytimes.com/view/david-rosmarin-md-on-che-heterogeneity-and-unmet-needs-in-ad-and-vitiligo
3. Rosmarin D, Eyerich K, Bauer A, Yu J. Late-stage AD pipeline review, clinical updates in CHE. Presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, Tennessee.
4. Joszt L. Chronic hand eczema linked to high costs, corticosteroid overuse. AJMC^®. May 20, 2026. Accessed July 14, 2026. https://www.ajmc.com/view/chronic-hand-eczema-linked-to-high-costs-corticosteroid-overuse
5. Shaw ML. FDA approves delgocitinib for moderate to severe hand eczema. AJMC. July 24, 2025. Accessed July 14, 2026. https://www.ajmc.com/view/fda-approves-delgocitinib-for-moderate-to-severe-hand-eczema
6. Jeremias S. Topical delgocitinib improves chronic hand eczema outcomes across all trial timepoints. AJMC. June 29, 2026. Accessed July 14, 2026. https://www.ajmc.com/view/topical-delgocitinib-improves-chronic-hand-eczema-outcomes-across-all-trial-timepoints