Treating Chronic Hand Eczema with Upadacitinib: Insights from Clinical Trials and Real-World Experience

Chronic hand eczema (CHE) is a chronic inflammatory skin condition that affects the hands and wrists causing itching, dryness, cracking, and pain. It often affects people with atopic dermatitis (AD) and can interfere with work and daily life. Topical therapies may have limited utility from ineffectiveness, poor adherence, or poor tolerability. Here, we evaluate oral upadacitinib (UPA) as a potential therapeutic alternative for patients with AD and refractory CHE.

This narrative review analyzed studies from PubMed, SCOPUS, and EMBASE evaluating CHE treatments. Eligible studies utilized the Hand Eczema Severity Index (HECSI), a validated clinician-reported outcome measure assessing CHE severity. HECSI-75 is the proportion of patients achieving at least a 75% improvement in clinical severity. Cases of three CHE patients from diverse demographics are presented.

In two phase 3 randomized controlled trials of UPA for moderate-to-severe AD, 94.8% (803/847) and 92.6% (774/836) of patients had CHE with HECSI assessments at baseline. Rapid improvement in CHE was observed in patients who received either dose of UPA (15 mg or 30 mg) as early as week 1 (P≤0.001 vs placebo). By week 8, up to 83% of UPA-treated patients achieved a statistically significant improvement in CHE (HECSI 75; P≤0.001 vs placebo). These benefits were sustained through week 16. Real-world clinical cases showed CHE patients experienced marked symptom relief within days of initiating UPA.

UPA-treated patients experienced rapid and sustained relief from CHE lesions, making it a promising therapeutic option for CHE patients for whom topical therapies are ineffective.