Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Advances in Chronic Hand Eczema: Pathogenesis, Biomarkers, and New Treatments
Description
The talk highlighted major advances in chronic hand eczema, a highly prevalent and often occupationally related disease affecting up to 10% of the population. It emphasized that chronic hand eczema is heterogeneous, commonly combining irritant contact dermatitis, allergic contact dermatitis, and atopic dermatitis features, with different immune pathways involved depending on the subtype and allergen. Irritant disease is associated mainly with Th1/Th17 inflammation, atopic disease with Th2/Th22, and allergens such as nickel, fragrance, and rubber can drive distinct immune profiles. A human biomarker study using tape strips and RNA sequencing showed that AD-related chronic hand eczema had stronger Th2/Th22 signals and barrier abnormalities, while non-AD disease showed stronger Th1/Th17 activity and other markers such as IL-23A and JAK1. These findings support more targeted therapy selection. The speaker noted the importance of noninvasive biomarkers for future research and treatment trials. Therapeutically, delgocitinib cream was highlighted as a newly FDA-approved topical treatment, and JAK inhibitors were presented as especially promising because they can address multiple inflammatory pathways across phenotypes. Dupilumab was described as useful for atopic hand eczema but less effective in Th1-driven disease. Overall, the field is moving toward biomarker-guided, phenotype-specific treatment for chronic hand eczema.
View moreConclusions
- Chronic hand eczema is highly prevalent and common in clinical practice, especially among occupationally exposed workers, creating a major unmet need for better long-term therapy.
- The disease is heterogeneous and can reflect irritant, allergic, atopic, or mixed mechanisms, so a single treatment strategy is unlikely to fit all patients.
- Different allergens drive different immune pathways, with nickel tending toward Th1/Th17 responses and fragrances or rubber more often associated with Th2/Th22 responses.
- Atopic chronic hand eczema appears biologically closer to atopic dermatitis, while non-atopic chronic hand eczema shows stronger Th1/Th17 skewing.
- Terminal differentiation and skin barrier abnormalities are present across chronic hand eczema phenotypes, but they are often more pronounced in atopic cases.
- Biomarkers correlate with disease severity and can help distinguish subtypes, supporting a more endotype-driven approach to chronic hand eczema.
- JAK inhibitors are especially promising because they can modulate multiple inflammatory pathways relevant to the diverse phenotypes of chronic hand eczema.
- Dupilumab is most suited to atopic, Th2-skewed chronic hand eczema, but it may be less effective when Th1-driven inflammation dominates.
- Non-invasive biomarker approaches such as tape strips are likely to be important for future research, patient stratification, and treatment-response studies.
- The overall conclusion is that chronic hand eczema is entering a more precise treatment era, guided by immunologic profiling and phenotype-specific therapy.
- Molin S, et al. Clin Exp Dermatol 2011.
- Leung D YM and Guttman-Yassky E, Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches. JACI. 2014;134:769-79.#10.1016/j.jaci.2014.08.008
- Dhingra N et al. JACI 2014.
- Bar J et al. Late Breaking abstract EADV 2023.
- Bar J et al. Allergy 2025.