At the recent FCPANP25 conference, a special presentation on chronic hand eczema (CHE) became the center of attention. Two authoritative experts, Dr. Andrea Murina and Dr. Linda Stein Gold, through in-depth analysis of the disease mechanism and cutting-edge therapies, brought hope for a breakthrough in this skin disorder that has plagued countless patients. This sparked extensive discussions among the medical professionals present.
The mystery of the disease: Diagnosis and treatment challenges due to multiple factors
Chronic hand eczema, as a typical multi-factor disease in dermatology, is far more complex than imagined. Dr. Andrea Murina emphasized in her presentation that the disease is characterized by persistent or recurrent symptoms, and variable skin morphology. It severely affects the quality of life of patients. Clinical data shows that approximately 70% of patients cannot complete fine work due to hand eczema, and nearly half of the patients exhibit social avoidance behaviors.
The diagnostic difficulties stem from the high overlap of causes. Irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis, etc., interweave with each other, making clinical diagnosis more difficult. From the perspective of the immune mechanism, multiple immune pathways such as Th1, Th2, Th17, and Th22 are abnormally activated, forming a complex inflammatory network, leading to a series of symptoms such as itching, redness, cracking, and desquamation on the skin. Dr. Linda Stein Gold particularly pointed out: “Hand eczema is not only a problem on the skin surface, but also a local manifestation of systemic immune imbalance. Patients often suffer from insomnia due to itching, which can lead to anxiety and depression and other psychological disorders.”
The traditional predicament: The benefits and drawbacks of corticosteroid treatment
For a long time, corticosteroid drugs have been the first-line treatment for chronic hand eczema due to their rapid anti-inflammatory properties. However, the potential side effects cannot be ignored. According to the latest clinical follow-up studies, 23% of patients who have used corticosteroids continuously for more than 6 months have experienced skin atrophy and thinning, 18% have developed local pigmentation, and 5% have developed steroid-dependent dermatitis. Moreover, once the medication is stopped, about 65% of patients relapse within 3 months, forming a vicious cycle of “medication relief – relapse after stopping medication”.Several dermatologists at the conference exchange feedback that some patients, due to long-term external use of corticosteroid ointments, have made their hand skin fragile and prone to damage, even affecting normal grip strength, causing irreversible impacts on their career development. This contradiction between efficacy and risk has forced the medical community to urgently seek safer and more effective alternative solutions.
The dawn of innovation: JAK inhibitors leading to treatment transformation
Among various research directions, local JAK inhibitors show remarkable potential. Delgocitinib, as a representative of broad-spectrum JAK inhibitors, has delivered outstanding results in the III phase clinical trial: 40% of patients achieved “clearance” or “almost clearance” of skin symptoms, and the drug’s systemic absorption rate is less than 0.5%, greatly reducing the risk of systemic side effects. What is more notable is that it has minimal skin irritation, and 90% of patients complete the full course of treatment.Ruxolitinib, which has been approved for the treatment of atopic dermatitis, has also performed well. In the expanded clinical trial for chronic hand eczema, this drug not only significantly improved the PASI score (Psoriasis Area and Severity Index) of patients, but also demonstrated good safety, with no serious adverse reactions reported. The emergence of these two drugs provides a “steroid-free” treatment option for moderate to severe patients, potentially rewriting the current treatment landscape.
Future outlook: The advent of the era of precision medicine
The two experts summarized that the breakthrough of JAK inhibitors is only the beginning. With the deep application of gene sequencing technology and artificial intelligence in dermatological research, “precision diagnosis and treatment” is expected to be achieved in the future – by analyzing the abnormal immune pathways of individual patients and customizing personalized treatment plans. Currently, many pharmaceutical companies have initiated clinical trials of JAK inhibitor combination therapies to explore the possibility of synergistic enhancement with immunomodulators and biological agents.”We are at the critical point of transformation in the treatment of chronic hand eczema,” Dr. Andrea Murina said. “This transition not only involves upgrading the therapy but also represents a revolution in medical concepts.” The medical community calls for accelerating the new drug approval process to enable innovative therapies to benefit patients sooner and completely unlock the treatment secrets of chronic hand eczema.
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