Serious Chronic Hand Eczema: Topical Treatments
Topical Delgocitinib Cream Shows Promise for Chronic Hand Eczema
Published: April 30, 2025
A new study published in The Lancet indicates that a topical cream containing delgocitinib is more effective and better tolerated than oral altretinoin for patients suffering from severe chronic hand eczema.
Understanding Chronic Hand Eczema
Chronic hand eczema, defined as eczema persisting for more than three months or recurring multiple times within a year, is a common inflammatory condition affecting the hands and wrists. The condition is associated with pain, itching, and meaningful impact on employment, psychosocial well-being, and socioeconomic status.
While topical corticosteroids are often the first line of treatment, prolonged use can lead to dermal atrophy and other adverse skin events. Systemic therapies may be required for severe cases, but topical corticosteroids may prove insufficient.
Oral altretinoin, a retinoid, is currently approved in some regions for severe chronic hand eczema in patients unresponsive to potent topical corticosteroids. However,safety limitations necessitate the advancement of therapies that effectively control the disease with a safety profile suitable for long-term use,researchers noted.
Delgocitinib Cream: A Novel Approach
Delgocitinib cream is a topical inhibitor of Janus kinases (JAK), which play a role in skin barrier dysfunction and inflammation associated with chronic hand eczema. phase III trials, Delta 1 and Delta 2, demonstrated significant betterment in key effectiveness endpoints and good tolerability compared to a vehicle cream. The Delta 3 open study further supported its long-term use.
Delta Force Study: Comparing Delgocitinib to Oral Altretinoin
The phase III Delta Force study,a randomized,evaluator-blinded trial,directly compared delgocitinib cream to oral altretinoin. The study was conducted across 102 centers in several European countries and canada to assess the effectiveness and safety of the topical cream versus the oral medication.
A total of 513 adult patients (65% women) with severe chronic hand eczema, defined by a score of 4 on the Investigator’s Global assessment for Chronic Hand Eczema (IGA-CI), and inadequate response to topical corticosteroids, were enrolled. Participants were assigned to receive either delgocitinib cream (20 mg/g) twice daily or oral altretinoin (30 mg) onc daily for up to 24 weeks. Emollients were permitted in both groups, and patients maintained their usual skin care routines.
The primary endpoint was the change in the Hand Eczema Severity Index (HECSI) score from baseline to week 12. Secondary endpoints included a 90% or greater improvement in HECSI score (HECSI 90) at week 12, IGA-CI treatment success at week 12 (score of 0/1, indicating clear or almost clear skin), and the change in HECSI score from baseline to week 24.
Key Findings: Delgocitinib Cream Proves Superior
The study revealed a substantially greater average reduction in HECSI score from baseline to week 12 with topical delgocitinib (-67.6) compared to oral altretinoin (-51.5), a difference of -16.1 (p < 0.0001). The HECSI score reduction at week 24 also favored the delgocitinib group. Differences between the treatment groups were observed as early as week 1 and continued to increase through week 24.
A significantly higher percentage of patients in the delgocitinib cream group achieved HECSI 90 at week 12. From week 1 through week 24, the percentage of patients responding to treatment was consistently greater in the delgocitinib group.
At week 12, a significantly greater percentage of participants in the delgocitinib group achieved IGA-CI treatment success, a trend that remained consistent from week 1 onward.
Among patients with a baseline Dermatology Life Quality Index (DLQI) score of at least 4, a higher percentage treated with delgocitinib experienced an improvement of at least 4 points from baseline to week 12 (72% vs. 56%, p = 0.0005) and from baseline to week 24 (71% vs. 48%, p < 0.0001).
Notably, fewer patients reported adverse events in the delgocitinib group (49%) compared to the altretinoin group (76%), with headache (4% vs. 32%), nasopharyngitis (12% vs. 14%), and nausea (<1% vs. 6%) being the most common.
“The data of the Delta Force study support the benefits of delgocitinib in cream as a topical effective treatment and well tolerated for this population of patients with a high load of illness and dissatisfied therapeutic needs,”
Authors of the Delta Force Study
The authors concluded that delgocitinib cream offers a non-steroidal topical option that effectively controls the disease without the safety concerns associated with long-term use of topical corticosteroids and systemic therapies.
Reference
Giménez-Arnau AM et al. Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial. Lancet. 2025 Apr 16:S0140-6736(25)00001-7.
Delgocitinib Cream for Chronic Hand Eczema: Your Questions Answered
Chronic hand eczema can be a debilitating condition, significantly impacting daily life. Fortunately, a recent study published in the Lancet offers promising news. This article will delve into the findings of the “Delta Force” study, exploring the effectiveness of delgocitinib cream as a potential treatment. We’ll break down the research and answer your most pressing questions.
What is Chronic Hand Eczema?
Chronic hand eczema is a persistent inflammatory skin condition that plagues the hands and wrists. It’s characterized by symptoms that last more than three months or recur multiple times within a year.This can lead to important challenges, including pain, itching, difficulties with employment, challenges in psychosocial well-being, and even socioeconomic complications.
What Causes Chronic Hand Eczema?
The exact causes of chronic hand eczema are often multifaceted. They can involve a combination of factors, including genetic predisposition, exposure to irritants or allergens (such as soaps, detergents, chemicals, or certain metals), and environmental triggers (like extreme temperatures). Additionally,psychological stress is also likely to exacerbate the condition.
What are the Existing treatments for Chronic Hand Eczema?
Depending on the severity of the condition, treatments vary. Initially, topical corticosteroids are a common first-line approach. However, long-term use of these can result in thinner skin and other adverse effects. Systemic therapies may be required for patients with more severe cases, yet these may not always be sufficient. A retinoid called oral altretinoin is approved in some regions for severe cases, but safety considerations are necessary.
What is Delgocitinib Cream?
Delgocitinib cream is a topical medication being investigated as a treatment for chronic hand eczema. It belongs to a class of drugs called janus kinase (JAK) inhibitors. These inhibitors work by targeting specific enzymes (JAKs) that play a role in the inflammation and skin barrier dysfunction associated with eczema. This approach offers a potential alternative to existing treatments, such as corticosteroids, with a perhaps more favorable safety profile.
What Did the “Delta Force” Study Investigate?
The “Delta Force” study was a phase III, randomized, evaluator-blinded trial. It directly compared the efficacy and safety of delgocitinib cream to that of oral altretinoin in adults with severe chronic hand eczema that was unresponsive to topical corticosteroids. The study took place in 102 centers across Europe and Canada.
Who Participated in the Study?
The study included 513 adult patients (65% women) who were diagnosed with severe chronic hand eczema. Participants had a score of 4 on the Investigator’s Global Assessment for Chronic Hand Eczema (IGA-CI), which indicates a vrey severe case, and had shown an inadequate response to topical corticosteroids.
How was the Study Conducted?
Participants were randomized to receive either delgocitinib cream (20 mg/g), applied twice daily, or oral altretinoin (30 mg) taken once daily for up to 24 weeks. Both groups were allowed to use emollients, and participants maintained their standard skincare routines throughout the trial.
What Were the Primary and Secondary Endpoints of the Study?
The primary endpoint was the change in the Hand Eczema Severity Index (HECSI) score from the start of the study (baseline) to week 12. The secondary endpoints looked at the following:
| Endpoint | description |
|---|---|
| HECSI 90 | Percentage of patients with a 90% or greater improvement in HECSI score at week 12. |
| IGA-CI Treatment Success | Percentage of patients achieving “clear” or “almost clear” skin (score of 0/1) on the IGA-CI at week 12. |
| change in HECSI | Change in HECSI score from baseline to week 24. |
| DLQI Improvement | What was the improvement in Dermatology life Quality Index (DLQI) among patients? |
What Were the Main Findings of the Study?
The study yielded compelling results:
- HECSI Score Reduction: Delgocitinib cream showed a significantly greater average reduction in the HECSI score from baseline to week 12 (-67.6) compared to oral altretinoin (-51.5). This difference was statistically significant. Differences between topically applied and ingested treatments were observed as early as week 1 and continued to increase through week 24.
- HECSI 90: A significantly higher percentage of patients in the delgocitinib cream group achieved a 90% or greater improvement in their HECSI score at week 12, and the trend remained consistent through week 24.
- IGA-CI Treatment Success: A significantly greater percentage of patients in the delgocitinib group achieved clear or almost clear skin (IGA-CI treatment success) at week 12 and beyond.
- Improved Quality of Life: Among patients beginning the trial with a DLQI score of at least 4, a higher percentage treated with delgocitinib experienced a meaningful improvement.
- Fewer Adverse Events: Fewer patients reported adverse events in the delgocitinib group (49%) compared to the altretinoin group (76%).
Is Delgocitinib Cream Better Than Oral Altretinoin?
Yes, a clear conclusion from the Delta Force study is that delgocitinib cream demonstrated superior efficacy and a more favorable safety profile than oral altretinoin for patients with severe chronic hand eczema.
What Are the Potential Side effects of Delgocitinib Cream?
The study indicated that delgocitinib cream was generally well-tolerated. Fewer patients experienced adverse events in the delgocitinib group compared to the altretinoin group. The most common adverse events reported, were headache (4%), nasopharyngitis (12%), and nausea (<1%).
What Did the Authors Conclude?
The authors concluded that delgocitinib cream offers a non-steroidal topical option that effectively controls the disease without the safety concerns associated with long-term use of topical corticosteroids and systemic therapies.
What Makes Delgocitinib Cream an Encouraging Option?
Delgocitinib cream may offer several advantages. It’s a topical treatment, allowing for targeted application directly to the affected areas. The study suggests delgocitinib cream is more effective and better tolerated than an existing oral treatment (altretinoin) and avoids some of the risks associated with the long-term use of corticosteroids or systemic therapies.
Where Can I Learn More about This Study?
The full study, “Efficacy and safety of topical delgocitinib cream versus oral alitretinoin capsules in adults with severe chronic hand eczema (DELTA FORCE): a 24-week, randomised, head-to-head, phase 3 trial” by Giménez-Arnau AM et al., was published in the Lancet on April 16, 2025. You can access the study here.
to sum up
The findings of the Delta Force study are encouraging for individuals struggling with chronic hand eczema. Delgocitinib cream appears to be a promising new treatment option, offering a potentially more effective and better-tolerated alternative to existing therapies.