Tralokinumab for Chronic Hand Eczema: A 52 Week Observational Case Series

Chronic hand eczema (CHE) is a multifactorial inflammatory skin disorder with substantial impact on quality of life and work productivity. Systemic treatment options are limited, and published evidence on the use of tralokinumab, an interleukin-13-targeted monoclonal antibody approved for atopic dermatitis, in CHE is limited.

To evaluate the effectiveness and safety of tralokinumab in adults with moderate-to-severe CHE refractory to topical therapy in an observational setting.

We conducted a retrospective observational study at a tertiary dermatology center. Adults with moderate-to-severe CHE, refractory to high-potency topical corticosteroids and/or calcineurin inhibitors, received subcutaneous tralokinumab (600 mg initial dose, then 300 mg every 2 weeks). Concomitant topical therapy was allowed. Disease severity was assessed using the Hand Eczema Severity Index (HECSI) at baseline and weeks 4, 16, 32, and 52. Responses were assessed achieving HECSI-50, HECSI-75, HECSI-90, and complete clearance (HECSI-100). Data on demographics, disease duration, clinical and etiological subtypes, safety, and response after dose adjustment were collected.

Sixteen patients (8 men, 8 women; mean age 56.5 years) were included. Baseline mean HECSI was 120.3. By week 52, 100% achieved HECSI-75, 92.3% HECSI-90, and 53.8% HECSI-100. Dose adjustment to 300 mg every 4 weeks was feasible in 62.5% with maintenance of clinical response. No serious adverse events occurred.

Tralokinumab appears associated with clinically meaningful improvement and is well tolerated in severe CHE refractory to topical therapy, including hyperkeratotic and non-atopic forms. Response rates and maintenance after dose adjustment suggest its potential role in CHE management.