Effective Topical JAK Inhibitors: New Hope for Chronic Hand Eczema

What happened at the Horizons in Advanced Practice meeting

The second annual Horizons in Advanced Practice meeting took place in Tampa, Florida, bringing together physician assistants and nurse practitioners from across the U.S. to review complex cases and hear expert-led sessions on atopic dermatitis, psoriasis, chronic hand eczema, and hidradenitis suppurativa. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)

One of the breakout sessions focused on practical, clinic-ready approaches to patients whose diseases don’t behave like textbook cases — especially those with chronic and treatment-resistant hand eczema. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)

Spotlight on chronic hand eczema (CHE)

In her session, Lakshi Aldredge, MSN, ANP-BC, DCNP, FAANP, a dermatology nurse practitioner with the VA Portland Health Care System, outlined evolving strategies for recognizing disease differences, grading severity, and bringing newer nonsteroidal options into long-term care plans. (Source: Presentation by Lakshi Aldredge, Horizons in Advanced Practice meeting, Tampa, 2024)

How chronic hand eczema is defined and why it matters

Chronic hand eczema (CHE) is generally defined by persistence — skin disease that lasts longer than 3 months or that relapses at least twice a year — and it commonly causes both pain and itch that interfere with work and daily tasks. (Source: Bissonnette R et al., DELTA trials, Lancet 2024)

Overlapping clinical types and what that means

More than half of patients with CHE show overlapping etiologic or morphologic subtypes, such as irritant contact dermatitis, allergic contact dermatitis, hyperkeratotic eczema, vesicular patterns, and even protein contact dermatitis, which makes diagnosis and treatment selection more complicated. (Source: Bissonnette R et al., DELTA trials, Lancet 2024)

Aldredge emphasized that this visible overlap reflects deeper differences in immune activity; depending on the subtype and exposures, disease can be driven by different T‑helper pathways — for example TH2/TH22 versus TH1/TH17 — which affects how well a therapy will work. (Source: Presentation by Lakshi Aldredge; Bissonnette R et al., Lancet 2024)

Why an accurate severity score changes treatment decisions

Because treatment escalation hinges on how severe the hands appear and function, Aldredge reviewed using the Investigator’s Global Assessment of Chronic Hand Eczema (IGA‑CHE), which grades both inflammatory signs (erythema, scaling, hyperkeratosis) and structural damage (vesiculation, edema, fissuring). (Source: DELTA trial methods, ClinicalTrials.gov)

Why the JAK‑STAT pathway matters in CHE

Multiple cytokines involved in CHE send their signals through the JAK‑STAT pathway, giving a clear biological reason to try topical Janus kinase (JAK) inhibitors across different subtypes of hand eczema. (Source: Bissonnette R et al., DELTA trials, Lancet 2024)

As Aldredge described it at the meeting, blocking JAK‑STAT signaling is like stopping a key from turning a lock: if that signaling is prevented, downstream inflammation can be reduced, which explains the rationale for topical JAK blockade. (Source: Presentation by Lakshi Aldredge, Horizons in Advanced Practice meeting, Tampa, 2024)

Delgocitinib (Anzupgo) — the clinical trial data

The phase 3 DELTA 1 (NCT04871711) and DELTA 2 (NCT04872101) randomized, double‑blind trials tested delgocitinib cream 2% (Anzupgo; LEO Pharma), a topical pan‑JAK inhibitor, in adults with moderate to severe CHE who had not achieved control with topical corticosteroids. (Source: ClinicalTrials.gov NCT04871711; ClinicalTrials.gov NCT04872101; Bissonnette R et al., Lancet 2024)

The primary end point was IGA‑CHE treatment success — defined as a score of 0 or 1 with at least a 2‑point improvement — and meaningful separation from placebo appeared as early as week 4 in both trials. (Source: Bissonnette R et al., Lancet 2024)

In DELTA 1, patients treated with delgocitinib achieved treatment success at a rate of 15.4% at week 4 compared with 4.9% on placebo, rising to 22.8% versus 10.5% at week 8 and remaining superior at week 16. (Source: Bissonnette R et al., Lancet 2024)

DELTA 2 showed similar findings, with 32.3% of patients on delgocitinib reaching treatment success at week 8 versus 9.4% on placebo. (Source: Bissonnette R et al., Lancet 2024)

How patients felt — itch and pain relief

Importantly, improvements weren’t just on the skin exam: symptom relief paralleled skin clearance, with significantly more patients reporting at least a 4‑point improvement on the Hand Eczema Symptom Diary for itch as early as week 2 and for pain by week 4, and these benefits were sustained through week 16. (Source: Bissonnette R et al., Lancet 2024)

Attendees at the meeting offered real‑world color: one clinician shared that a family member saw notable hand‑eczema improvement within a week of starting delgocitinib, underlining how quickly some people experience relief. (Source: Attendee comments, Horizons in Advanced Practice meeting, Tampa, 2024)

Durability and subtype analyses

Exploratory analyses suggested delgocitinib helped across multiple CHE subtypes, and long‑term extension data showed maintained responses with as‑needed use through 36 weeks, supporting both short‑term symptom control and longer‑term management strategies. (Source: Bissonnette R et al., Lancet 2024)

Aldredge told clinicians she often frames expectations by saying patients will usually see significant improvement by two weeks, and continued gains thereafter if treatment is maintained appropriately. (Source: Presentation by Lakshi Aldredge, Horizons in Advanced Practice meeting, Tampa, 2024)

Practical barriers: insurance and access

Even with strong clinical evidence, many clinicians at the meeting noted that getting delgocitinib into patients’ hands can be difficult because of insurance rules and cost barriers. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)

Medicare patients can face an “income paradox” in which they earn too much to qualify for assistance programs but still encounter high out‑of‑pocket costs for new therapies, a hurdle described by presenters and attendees. (Source: Presentation by Lakshi Aldredge; Attendee comments, Horizons in Advanced Practice meeting, Tampa, 2024)

Prior authorization and step therapy requirements were singled out as a major administrative burden: payers often demand objective documentation of disease severity and force clinicians to try and fail older therapies before approving a newer option. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)

Coverage can also be complicated when patients are already receiving systemic biologics; some payers restrict access to additional agents, which can delay or prevent appropriate topical therapy for the hands. Several clinicians noted differences in payer rules that affect whether topical JAK therapy is allowed alongside biologics. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)

One attendee observed that delgocitinib may be easier to justify to payers when it is prescribed specifically for the hands, even if the patient is on a biologic for broader disease — a practical distinction that can make a real difference in access. (Source: Attendee comments, Horizons in Advanced Practice meeting, Tampa, 2024)

Takeaway for clinicians and patients

For people with moderate to severe CHE who cycle through topical corticosteroids without sustained control, topical JAK inhibition offers a targeted, nonsteroidal alternative that aligns with what we know about disease biology and helps avoid the risks of chronic steroid use. (Source: Bissonnette R et al., Lancet 2024; Presentation by Lakshi Aldredge, Horizons in Advanced Practice meeting, Tampa, 2024)

Clinicians should combine careful assessment with clear conversations about expectations, duration of use, and access hurdles so patients get both the benefits of newer treatments and the support needed to obtain them. (Source: Presentation by Lakshi Aldredge; Horizons in Advanced Practice meeting, Tampa, 2024)

Sources

1. Bissonnette R, Warren RB, Pinter A, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double‑blind, phase 3 trials. Lancet. 2024;404(10451):461‑473. doi:10.1016/S0140-6736(24)01027-4 (Source: Lancet, DELTA 1 & DELTA 2 trials)
2. ClinicalTrials.gov. DELTA 1 — Delgocitinib in Chronic Hand Eczema. NCT04871711. (Source: ClinicalTrials.gov entry NCT04871711)
3. ClinicalTrials.gov. DELTA 2 — Delgocitinib in Chronic Hand Eczema. NCT04872101. (Source: ClinicalTrials.gov entry NCT04872101)
4. LEO Pharma. Anzupgo (delgocitinib) product information and press materials. (Source: LEO Pharma product information)
5. Horizons in Advanced Practice meeting, Tampa, Florida — presentations and attendee discussions, 2024. (Source: Horizons in Advanced Practice meeting, Tampa, 2024)
6. VA Portland Health Care System — provider affiliation for Lakshi Aldredge, MSN, ANP‑BC, DCNP, FAANP. (Source: VA Portland Health Care System)