Immunological Advancements In Hand Eczema Treatment: Progress With Small Molecules and Biologics

Purpose of Review: The integration of pharmacological insights into the treatment landscape of hand eczema (HE) is continuously evolving, driven by a deep understanding of immunological signaling pathways. This review aims to investigate the advancements in understanding and treating HE with small molecules and biologics. Specifically, we sought to answer how novel therapeutic targets and agents have influenced the management of HE. Recent Findings: Recent research has identified promising treatments involving monoclonal antibodies, such as dupilumab, tralokinumab, lebrikizumab, targeting IL-4 and IL-13, which reduce HE severity and improve quality of life. Emerging selective JAK inhibitors, including delgocitinib, gusacitinib, tofacitinib, upadacitinib, and abrocitinib, have demonstrated promising efficacy, pruritus reduction and are actively researched. Furthermore, topical PDE4 inhibitors, such as crisaborole, roflumilast, and difamilast cream, remain potential options for chronic HE, offering alternatives to conventional treatments like topical steroids or calcineurin inhibitors, as is botulinum toxin for vesicular HE. Summary: The examination revealed significant advancements in the treatment of HE with biologics and small molecules, suggesting a shift towards more personalized and precise dermatological strategies. Monoclonal antibodies and JAK inhibitors are emerging as effective options for HE management, offering improvements in symptom control and quality of life. Topical PDE4 inhibitors provide additional alternatives for chronic HE. These developments highlight the need for clinicians to stay updated on immunologic and therapeutic progress, as they can enhance management strategies and offer more comprehensive care options before considering systemic therapies. This evolving landscape may significantly impact future research and clinical practice in HE management.