The University of Nevada, Reno School of Medicine

PosterToPractice26 - Chronic Hand Eczema in Focus Clinical Lessons from the Latest Research

Chronic Hand Eczema in Focus: Clinical Lessons from the Latest Research

MD, FAAD

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Evaluate the efficacy and safety of current and emerging therapies for the treatment of CHE

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Eczema

On-Demand CME Videos

PosterToPractice: Chronic Hand Eczema in Focus: Clinical Lessons from the Latest Research

Hello, my name is James Song and I'm a dermatologist for Frontier Dermatology. And I welcome you to our poster to practice session where we're going to identify what I think are the most important and new and emerging research that was discussed here at the 2026 Winter Clinical Dermatology Meeting in beautiful Maui, and how we're going to distill that down to make it as practical for you. So you can use these tips when you get back to your clinic. Chronic hand eczema is one of the most common things that we treat as dermatologists. It's also one of the most difficult conditions. And we know that not only does this disease have a high impact on patient reported outcomes like itching and pain, we can have a significant impact on functional and societal burden as well. These patients often aren't able to work. You have to make significant changes in their activities of daily living and they just can't function how they want to because of this disease. Which is why it's so important that we welcome and use new and emerging therapies that can potentially treat this disease that has been historically undertreated. The good news is that we do now have new and emerging therapies in this space that I think this can be really exciting for our patients and for you as clinicians. So the very first and actually only therapy that we have approved for CHE is going to be Zelda Sitinib. This is a pan Jack topical inhibitor for 18 and up. But we also have other MOAs that are being investigated that you probably are all familiar with, including PDE4 inhibitors, monoclonal antibodies that target the IL4 receptor or the cytokine 13 blocker, as well as other topical JAK inhibitors that are being studied either in chronic hand eczema or atopic hand eczema. So the future is bright for our chronic hand eczema patients. The first poster I wanted to present is on a topic or a patient population that we see very frequently, but we don't really have a lot of studies on, and that's patients with atopic hand eczema, but they may not have extensive eczema elsewhere. As many of you know, most of our clinical trials or our systemic therapies were done in patients who had extensive body surface area and high easy scores. But those patients with limited hand eczema would not qualify for the study. So there's a really large gap there as far as can we use our systemic therapies to treat these patients. We now have a poster with Trilokinumab which is an interleukin 13 cytokine blocker, which is approved for moderate to severe atopic dermatitis. But this poster is looking primarily at patients who had moderate to severe hand eczema. And there wasn't a requirement to have extensive BSA or an easy score to get in here. Now, if you look here to the methodology section, the inclusion criteria was very straightforward. You're 18 and up, you had moderate to severe hand eczema based on an IGA scale and you had an itch score of at least 4 or greater. But there was no requirement to have 10% BSA or an easy 16. And patients got the label dose of trilokinumab or placebo. And the primary endpoint was at 16 weeks. Now, if you jump down here and look at the results section, this gives you a sense of how tough these patients were to treat. Nearly 30% of these patients were an IGA of 4. That is severe. And if you look at the average pecci score, Pecci is the hand analog of the EASI. It is in the upper 30s. To put that into context, a score of 38 and greater is considered to be severe. So we are skewing much more on the severe side in this patient population. And if you look at the results moving further along here, this was the primary endpoint. We want to get patients to completely clear or almost clear with monotherapy trailer kinumabs. And no topicals are allowed. And the definition of clear or almost clear here is you have barely perceptible erythema. The no scaling, no thickenings. That's a very high bar. And we see about four out of 10 patients achieving that primary endpoint, which is about four times greater than what we see with placebo. And you got some additional endpoints here, like the Hexi 75 or the Hexi 90. We're seeing very nice separation. And if you look at the patient reported outcomes, whether it's itch or pain reduction, we're seeing a dramatic reduction very, very quickly as well. And as far as the safety and tolerability, what you can expect with trilokidumab overall, very well tolerated, low discontinuation rates. And so the bottom line here is that if you got a patient who with moderate to severe hand eczema, even if they don't have bad eczema elsewhere, we should have confidence that we can use trilokinumab in that patient population. In this poster, we are going to build on what we just discussed from the previous poster and that is why do we need to treat chronic hand eczema? And what I'm going to show you is that if we use trilokinumab in these patients with moderate to severe hand eczema, not only are we improving on the itch and the pain, but we're also improving the impairment that these patients can have, whether it's at work or at school. So I want to just point you to this right here. We are looking at the activity impairment score. This is measuring how much does your disease impair you from your activities of daily living. And that green line is what trilocaneumab was. You're seeing a dramatic improvement in patients who took trilocumab versus those who did not. If you look at work productivity impairment, we're seeing a very consistent trend that patients who took tralikinumab had far less impairment in those who did not. And then presenteeism, even if you're there, you're not as productive as you want to be. We are seeing dramatic improvement with trailer kidumab versus placebo as well. So the bottom line is this. When you're assessing patients with chronic hand eczema, don't just ask about itching or pain, but ask about how much does this impair my day to day activities. And if it's significant, you may want to use a medication like trilocumab. Here we're looking at Delgo sitinib. This is the pan jack topical inhibitor for chronic pan eczema in their pivotal phase three studies. But I'm going to be talking about a subgroup of patients that we call super responders. But these are not patients who just get to the primary endpoint. These patients go beyond that and they get that deep, deep level of response. So let me take you to this section right here. The results we are looking at not just a full grade reduction in itch or pain. We're looking at little to no itch or little to no pain. And we're seeing about a third of patients achieving that at the primary endpoint. Also, if you look down here, these are patients who got to completely clear andelgo sitinib and then we stopped it. We wanted to see how long does it take for you to clear at eight weeks. So off a drug, about a third of patients were still clear or almost clear. And at 16 weeks, still 15 plus percent of patients. So if you got a patient on delgocitinib and they're doing great on a drug, you can actually give them a drug holiday. All right, so we'll Be building on the previous talk that we just had on dalgosytinib, the same study for chronic an eczema. But now we're trying to figure out how long does it take for someone to have a meaningful improvement in their itch and in the pain. So let's just cut to the chase. Here's the Results section. Figure 1. We are looking at a two point improvement in niche. That's considered to be the bare minimum for a clinically meaningful improvement. And it happens as early as one day for the itch. If you jump to figure four, this is now looking at pain, a two grade reduction in pain as early as day three. So you don't have to wait 16 weeks to get a meaningful improvement. We're seeing this sometimes happen within days. This last poster is answering a question I think many of our colleagues are going to have. That is you're using a pan Jak inhibitor. Even if it's a topical, do I have to worry about it from a safety standpoint? So what we're going to be looking at here is the systemic exposure of this drug when you use it under normal circumstances as well as max use circumstances. Let me point you to table one. I'm showing you two studies, Delta two, that's the phase three study for chronic hand eczema. And then we have a phase one study for atopic dermatitis. Or it's pretty moderate to severe atopic dermatitis. And I want to draw your eye to this column right here. You can see that under normal circumstances people are using it at 7 grams and max usage, double that, so 14 grams. And then the atopic dermatitis studies over 70 grams per week, translating to a body surface area of 33%. That's a third of your body. And if I can move you over that to figure 1. The y axis is going to be the amount of adelagositinib that's detected in the blood. This top line here is the threshold of when you're going to get immunosuppression. The bottom line here is going to be what you get with the lowest dose of dalgositinib, which is considered to be a sub therapeutic dose. And now let's look at how much dalgosinib is detected in the blood and what we're seeing under normal or max use conditions. And even in atopic dermatitis where they're using up to 33% of the body surface area, it is well below the threshold for either immunosuppression or what you're getting with the oral version, the lowest oral version of dalgalicidinib. So that should give us confidence in our patients that if you're using this as you should be, or even in max use circumstances, you're going to be getting negligible amounts of drug in your blood. I wanted to report findings from now the largest cross sectional survey that has been done in chronic hand eczema in the US These are adults with self reported but physician diagnosed chronic hand eczema. And this is going to really help us better characterize a disease that has been historically poorly understood and poorly characterized. So a couple points I want to make here is that the prevalence in the US is roughly about 10%, making that one of the most common inflammatory skin diseases that we treat as dermatologists. We also found that patients who are male, under the age of 40 and those that are employed and living in urban areas were more commonly afflicted. And also patients tend to have chronic hand eczema half the times primarily on the hands, about a third of the time on the hands and the wrists, and a minority of cases just on the wrist alone. When you look at the chronicity of chronic panexima, we see that in about three out of four cases, these patients not only have it for longer than three months, but they also have at least two flares on top. So the vast majority of our patients are having this chronic disease that we can't just be treating willy nilly with topical or systemic steroids. And so I hope this is helpful because I think the more we learn about the disease, the better we're gonna be able to treat it. So it's a great time to be treating chronic hand eczema. We talked about our first FDA approved treatment for chronic hand eczema, but the pipeline is rich. It's exciting. We now have several different drugs that are under study for atopic hand eczema or chronic hand eczema. And I am confident and optimistic that the field is going to continue to move forward so that we can better treat our patients with this debilitating disease.

PosterToPractice: Chronic Hand Eczema in Focus: Clinical Lessons from the Latest Research

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