The Treatment Landscape and Economic Burden of Chronic Hand Eczema
Key Takeaways:
- The heterogeneous nature of chronic hand eczema (CHE) makes disease management challenging: A large percentage of patients with CHE have more than 1 disease subtype and switch between treatment options, which makes it difficult to develop uniform treatment standards.
- Treatment for CHE is characterized by corticosteroid reliance: Most patients included in the study were treated with corticosteroids, with 81.3% receiving topical corticosteroids and 86.2% receiving systemic corticosteroids.
- Care costs increase with treatment escalation: Patients receiving more intense therapy options such as monoclonal antibodies or Janus kinase (JAK) inhibitors accumulated higher costs than those receiving systemic corticosteroids.
The treatment landscape for CHE is varied and heterogeneous. The JAK inhibitor delgocitinib was recently approved by the US Food and Drug Administration (FDA) to treat moderate to severe CHE. Before this, patients were typically treated with corticosteroids, despite overreliance being associated with adverse events such as hypertension, myocardial infarction, adrenal suppression, hyperlipidemia, diabetes, and infection.
Study Methods and Outcomes
Researchers conducted a comprehensive evaluation of real-world treatment patterns and care costs among patients with moderate to severe CHE. Using the Komodo Research Data database, investigators identified 6295 patients with CHE who were treated between January 2016 and April 2024.
Patients were assigned to 3 cohorts. Cohort 1 included patients who received systemic therapy. Patients in cohort 2 received a more intense form of therapy; namely, systemic therapy besides corticosteroids (such as immunosuppressants or JAK inhibitors). Patients in cohort 3 received the most intense therapy and were treated with either monoclonal antibodies or JAK inhibitors.
Patient Characteristics
Among the 6295 patients included in the study, 3529 (56.1%) patients were in cohort 1, 551 (8.8%) made up cohort 2, and 239 (3.8%) were in cohort 3.
Patients were also characterized by CHE subtype, including atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and unspecified contact dermatitis. Approximately 45% of patients in the study had multiple subtypes, highlighting the heterogeneous nature of CHE.
Treatment Patterns
The majority of patients were treated with corticosteroids, with 81.3% receiving topical corticosteroids and 86.2% receiving systemic corticosteroids.
Cohorts 2 and 3 had higher rates of topical therapy than cohort 1, 88.4% and 93.3% vs 86.2%, respectively. All patients received some form of systemic therapy, and the use of systemic corticosteroids was high among all cohorts.
Treatment patterns varied during study period, and patients often switched between systemic, topical, and no treatment options, reflecting the challenge of CHE management and the need for specific treatment guidelines.
Economic Burden
Health care utilization was largely driven by outpatient visits, which increased with treatment intensity. Cohorts 1, 2, and 3 had an average of 1.3, 3.0, and 4.7 days per patient per year (PPPY), respectively.
Care costs associated with CHE treatment also increased across cohorts. Average total costs were $1876 PPPY in cohort 1, $9505 PPPY in cohort 2, and $21 682 PPPY in cohort 3.
Pharmacy costs were large factors of total health care spending, averaging to $1221 PPPY in cohort 1, $8898 PPPY in cohort 2, and $20 760 PPPY in cohort 3. Patients receiving monoclonal antibodies or JAK inhibitors accumulated higher pharmacy costs, showcasing the increased economic burden among advanced therapies.
Implications for Managed Care
This study illustrates the varied nature of CHE management. Procedural treatment includes extensive corticosteroid use despite the documented risks of reliance, indicating the need for safe and effective CHE-specific therapies.
Considering how more intense therapies are associated with higher care costs, reducing treatment escalation should be a primary focus in future studies.
The authors said, “Adoption of novel therapies is required to reduce corticosteroid reliance and prevent therapeutic escalation among adults with moderate to severe CHE in the USA.”
Reference
Armstrong AW, Burne R, Bin Sawad A, et al. Treatment patterns and economic burden in moderate to severe chronic hand eczema in the USA: a real-world retrospective claims analysis. Dermatol Ther. 2026;16:3013–3026. doi:10.1007/s13555-026-01755-5
