Abstract
Background:
Chronic hand eczema (CHE) is defined as hand eczema persisting for >3 months or recurring at least twice within 12 months and is associated with significant pruritus, pain, functional impairment, and psychosocial burden. Conventional treatments are frequently inadequate or limited by adverse events (AEs). Topical Janus kinase inhibitors represent a novel therapeutic option. While delgocitinib has recently been approved for CHE, emerging evidence suggests topical ruxolitinib may also be effective.
Objectives:
To evaluate the real-world efficacy and safety of topical ruxolitinib 1.5% cream in patients with moderate-to-severe CHE.
Methods:
This retrospective real-world case series included 13 patients with CHE treated with ruxolitinib 1.5% cream applied twice daily for ~12 weeks. Baseline demographic and clinical characteristics were collected, including CHE subtype and disease severity. Treatment response was assessed using the Physician’s Global Assessment (PGA).
Results:
The cohort included 8 females and 5 males with a mean age of 33.8 years and mean disease duration of 6.9 years. Most patients had hyperkeratotic CHE (76.9%), with all exhibiting moderate-to-severe disease at baseline (PGA 3-4). By week 12, 92.3% of patients achieved a PGA score of 0 or 1, indicating clear or almost clear disease. No treatment-related AEs were reported during follow-up.
Conclusions:
Topical ruxolitinib demonstrated high rates of clinical improvement and favorable tolerability in this real-world CHE cohort. Despite limitations including small sample size and retrospective design, these findings support ruxolitinib as a promising option for recalcitrant CHE and warrant confirmation in larger randomized controlled trials.
Introduction
Chronic hand eczema (CHE) is often associated with significant pruritus and/or pain, functional limitation, and psychosocial distress. 1 Existing treatments, including topical corticosteroids, topical calcineurin inhibitors, phototherapy, and systemic agents, are often ineffective or limited by adverse events (AEs). 2 Topical Janus kinase (JAK) inhibitors offer a novel therapeutic approach for CHE. Recently, delgocitinib cream, a pan JAK inhibitor, has been approved for the treatment of CHE. Ruxolitinib, a topical JAK1/2 inhibitor, is approved for mild-to-moderate atopic dermatitis. 3 Recent clinical trials demonstrated that ruxolitinib is a promising treatment for CHE, showing significant improvements in clinical outcomes, pruritus, and quality of life.4,5 This real-world retrospective study highlights the efficacy of topical ruxolitinib 1.5% cream in CHE, contributing to the growing body of evidence supporting topical JAK inhibitors for CHE.
The study included 13 patients (8 female, 61.5%) diagnosed with CHE, with a mean age of 33.8 years and a mean disease duration of 6.9 years. Table 1 summarizes baseline demographic and clinical characteristics of the patients. Most patients had predominantly hyperkeratotic hand eczema (10/13, 76.9%), followed by fingertip hand eczema (2/13, 15.4%) and dyshidrotic hand eczema (1/13, 7.7%), with all cases exhibiting moderate-to-severe disease at baseline. This is a real-world study, and patients applied ruxolitinib 1.5% cream twice daily for 12 weeks (10-14 weeks), and treatment response was assessed using the Physician’s Global Assessment (PGA) score. At baseline, all patients had PGA 3/4 (8 patients had PGA 3 and 5 patients had PGA 4). Approximately 92.3% of patients achieved a PGA score of 0 (n = 4, 30.8%) or 1 (n = 8, 61.5%) by week 12 (Table 2 and Figure 1). Representative before‑and‑after images are shown in Figure 2. Notably, no treatment-related AEs were reported during the 12 week follow-up period. These findings suggest that ruxolitinib may represent a potentially effective and well-tolerated option for the treatment of CHE, particularly in those who have not responded to conventional topical or systemic therapies.
Baseline Demographic and Clinical Characteristics of Patients With Chronic Hand Eczema Treated With Topical Ruxolitinib (n = 13).
Abbreviations: DHE, dyshidrotic hand eczema; FTE, fingertip eczema; HHE, hyperkeratotic hand eczema; IgE, immunoglobulin E; NB-UVB, narrowband ultraviolet B; SD, standard deviation; TCS, topical corticosteroids.
Clinical Outcomes at Baseline and Week 12 Following Topical Ruxolitinib (n = 13).
Abbreviation: PGA, Physician Global Assessment.
Clinical outcomes at baseline and week 12 following topical ruxolitinib (n = 13). Data shown as percentage of patients. (A) PGA demonstrates a shift toward lower disease severity at week 12 compared with baseline. (B) Symptom profile distribution at baseline and week 12, categorized by presence of pain and/or pruritus. (C) Proportion of patients reporting any pain and any pruritus at baseline and week 12, demonstrating a reduction in both symptoms following treatment. Baseline values are shown in gray and week 12 values in green. PGA, Physician Global Assessment.
Clinical images of 2 patients with CHE before and after 12 weeks treatment with topical 1.5% ruxolitinib cream twice daily. (1A, 1B) Patient 1 with hyperkeratotic hand eczema (PGA 4), pre- and posttreatment. (2A, 2B) Patient 2 with dyshidrotic hand eczema (PGA 3), pre- and posttreatment. CHE, chronic hand eczema; PGA, Physician Global Assessment.
The study results are consistent with previous research on the efficacy of ruxolitinib in treating CHE.4,5 The favorable safety profile of topical ruxolitinib, with minimal systemic absorption, makes it an appealing option for long-term management. However, the limitations of this study must be acknowledged. The small sample size and retrospective nature of the analysis prevent definitive conclusions about the drug’s efficacy and generalizability. In addition, the real-world design introduces heterogeneity in prior treatments, disease chronicity, and concomitant use of various over-the-counter moisturizers.
Future randomized controlled trials with larger sample sizes and longer follow-up periods are needed to confirm these findings and establish ruxolitinib’s role in CHE management. Nevertheless, this study provides preliminary evidence supporting its use as a promising treatment option for patients with recalcitrant CHE. This represents one of the first real-world case series evaluating topical ruxolitinib for CHE.
Footnotes
Ethical Considerations
This study was a retrospective review of de-identified patient data conducted in accordance with institutional guidelines.
Consent to Participate
Written informed consent was obtained from all participants prior to data collection.
Consent for Publication
Consent for the publication of data was obtained by the authors and included at the time of article submission to the journal, stating that all patients gave consent with the understanding that this information may be publicly available.
Author Contributions
M.A.-H. conceived the study, served as principal investigator, and oversaw data collection. M.M. performed the data analysis and drafted the manuscript. G.A. and A.A.-H. provided critical revisions. C.S. obtained ethics approval. All authors reviewed and approved the final manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data supporting this study are not publicly available due to patient privacy and institutional ethics restrictions. De‑identified data may be made available from the corresponding author upon reasonable request.