Patients Would Trade Itch Relief to Avoid Cancer Risk in Hand Eczema

Asked to choose between a treatment that clears the itch and one carrying a sliver of cancer risk, adults with chronic hand eczema (CHE) say they would take the safer option and would surrender a striking amount of symptom relief for it. In a discrete choice experiment among 300 US adults, participants would forgo 28.1 percentage points of itch improvement to lower cancer risk by a single percentage point.¹

A Treatment Landscape That Changed Underneath Patients

CHE is a fluctuating inflammatory disease of the hands and wrists lasting at least 3 months, or flaring twice or more within a year. Topical corticosteroids and calcineurin inhibitors remain first-line, with phototherapy or systemic therapy reserved for refractory disease.

What has changed sits beyond those topicals. Delgocitinib cream, a topical pan-Janus kinase inhibitor, beat the vehicle in the phase 3 DELTA 1 (NCT04871711) and DELTA 2 (NCT04872101) trials, with week 16 treatment success in 20% and 29% of treated patients vs 10% and 7% on the vehicle.² It became the first therapy the FDA approved specifically for moderate to severe CHE in July 2025, and dupilumab, tralokinumab, abrocitinib, and gusacitinib have all been studied in the disease or its subtypes. Each carries a different route, schedule, and safety profile, and little was known about which tradeoffs patients actually weigh.¹

Seven Attributes, 300 Participants, 10 Choice Cards Each

Attributes came from a literature review, 15 one-on-one patient interviews, and clinical expert input, then narrowed to 7: improvements in itch, skin appearance, and pain; risks of infection, cancer, and major heart problems; and mode and frequency of administration. Sixty choice cards built on a D-efficient design were split into 6 blocks, so each participant completed 10 cards plus 2 validity tests, analyzed with conditional logistic regression.

Participants were recruited from online panels and surveyed between August and September 2025. The mean age was 44.9 years, half were women, and 84.7% were employed. Most reported multiple CHE subtypes (70.3%), most commonly atopic (60.3%) and irritant (52.3%). The burden showed up in ordinary life: 96.3% reported impairment in daily activities, most often household chores (70.0%) and handwashing (69.3%), and among employed participants who worked at all in the prior week, mean impairment while working reached 51.9%.

Efficacy Led, but Cancer Risk Was the Deal Breaker

Every attribute significantly influenced choice (P < .001). Itch improvement carried the greatest relative importance at 22%, followed by skin appearance at 21%, avoiding cancer risk at 16%, avoiding infection risk at 14%, pain improvement at 13%, administration at 7%, and risk of major heart problems at 6%.

The willingness-to-trade-off analysis put those rankings in sharper relief. Participants would accept a 28.1-percentage-point reduction in the probability of meaningful itch improvement to avoid a 1-percentage-point cancer risk, compared with 11.4 points for major heart problems and 1.3 points for infections. These risks were hypothetical levels on unbranded treatment profiles, not observed rates for any marketed CHE therapy. On delivery, they preferred twice-daily topical application over an injection every 2 weeks, though administration ranked near the bottom on importance. A sensitivity analysis restricted to the 186 participants (62.0%) who passed both validity tests produced similar weights and rankings.

A separate finding pointed at the consultation rather than the drug. Nearly 1 in 4 participants (22.7%) said their clinician presented only one option when their current therapy was chosen, 75.7% recalled discussing efficacy, and 59.7% recalled discussing adverse-effect risk.

What the Design Cannot Answer

“These findings reaffirm that CHE extends beyond clinical symptoms, and its functional impact on work productivity and daily living underscores the need for more effective, durable, and convenient treatment options specifically approved for CHE to mitigate patient burden,” the authors wrote.

The survey drew on an online panel and relied on self-reported diagnosis, raising the prospect of selection bias and misclassification, and recall bias is inherent to the format. The attribute list was deliberately short to limit response burden, so factors patients value may be missing. Conditional logistic regression also assumes preference homogeneity, and the study was not powered to test whether systemic-experienced patients weigh risk differently from systemic-naive ones.

Sponsorship deserves weight alongside those limits. The study was funded by LEO Pharma, which markets delgocitinib cream; 3 coauthors are LEO Pharma employees, and 5 more are affiliated with Analysis Group, a consultancy. Patients favoring a twice-daily topical over a biweekly injection runs in the sponsor's commercial direction, a reason to weigh that result more carefully than the efficacy-versus-safety rankings driving the paper.

For clinicians, the usable signal is that the safety conversation is not padding around an efficacy pitch: avoiding cancer risk outweighed pain relief in these rankings. Payers weighing a class that now spans creams, injections, and oral agents may find the adherence read more useful, since it may track less with convenience than with whether the risk profile was ever explained.

References

1. Armstrong AW, Bin Sawad A, Hazra NC, et al. Patient preferences for treatment attributes in moderate to severe chronic hand eczema: a discrete choice experiment. Dermatol Ther (Heidelb). 2026;16(8):3979-3999. doi:10.1007/s13555-026-01818-7

2. 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