Letter: Tralokinumab for the Treatment of Chronic Hand Eczema: A Retrospective Case Series with Long-Term Follow-up

To the Editor:

Chronic hand eczema (CHE) has a significant impact on the quality of life despite the limited body surface area affected. Management of CHE poses several challenges, such as lack of universally acceptable therapies and the need for long-term treatment.

The current therapeutic ladder of CHE mirrors that of atopic dermatitis (AD) in the pre-biological era. ¹ Recently approved therapies include dupilumab, an interleukin (IL)-4 and 13 blocker for atopic CHE, and delgocitinib, a topical pan-JAK inhibitor (JAKi). Tralokinumab, a monoclonal antibody selectively targeting IL-13, is approved for moderate to severe AD. Data on its use exclusively for CHE are limited. ² We present this series of 6 CHE patients treated with tralokinumab with long-term follow-up.

A retrospective chart review of CHE patients treated with tralokinumab from January 2022 to December 2024 was performed. Search words used in clinic notes were “chronic hand eczema” and “tralokinumab.” Patients with a minimum follow-up of 16 weeks were included. Clinical photographs and Hand Eczema Severity Index (HECSI) scores at baseline, weeks 16 and 52 (if available) were compared.

We identified 6 adult CHE patients on tralokinumab (4 males, 2 females, mean age 45.5 ± 20.5 years, Table 1). Four patients were non-atopic, of whom 2 had additional foot involvement. Two patients had atopic CHE with mild concomitant AD. Three patients had a mixed pattern and 3 vesicular CHE. A skin biopsy was performed in 4 patients. Patch testing was negative in the 4 patients tested. At 16 weeks, 3 (50%) achieved HECSI 90, and 3 (50%) had achieved HECSI 75. Long-term data was available for 4 patients who achieved HECSI 100 at week 52 and continued to receive tralokinumab. The longest follow-up is 28 months. One patient was lost to follow-up after 6 months, and 1 was on irregular treatment over the 3 years. The only side effect observed was mild injection site reactions in 1 patient.

Table 1.

Patient Demographics and Treatment Course of 6 Patients of Chronic Hand Eczema Treated with Tralokinumab

No	Age (Years), Sex	Duration (Years) at Tralokinumab Initiation	Clinical Pattern	Associated AD	Skin Biopsy Confirmation	Patch Testing	Previous Therapy	Baseline HECSI Score	HECSI Score (16 Weeks)	HECSI Score (52 Weeks)	Concomitant Use of TCS	Adverse Effects	Follow-up (Months)
1	25, M	10	Mixed (hyperkeratotic and pulpitis)	Yes	No	No	Oral steroids, TCS	78	15	NA	No	None	18, irregular treatment
2	42, F	2	Vesicular, foot involvement +	No	Yes	Yes	Oral steroids, TCS, TCIs	76	14	0/0	Occasional	Injection site reactions	28
3	66, M	10	Vesicular, foot involvement +	No	Yes	Yes	IM steroids, TCS	102	15	NA	Occasional	None	6, lost to follow-up
4	54, M	1	Mixed (hyperkeratotic and pulpitis)	No	Yes	Yes	TCS, TCIs	80	5	0/0	No	None	20
5	28, M	1	Vesicular	No	No	Yes	TCS, TCIs	55	8	0/0	No	None	18
6	30, F	2	Mixed (hyperkeratotic and pulpitis)	Yes	Yes	No	TCS, TCIs	209	9	0/0	No	None	18

AD, atopic dermatitis; HECSI, Hand Eczema Severity Index; Note: HECSI Score ranges from 0–360 points. Almost clear is 1–16 points, moderate: 17–37 points, severe is 38–116 points and very severe is 117 points or higher, TCS, topical corticosteroids; TCIs, topical calcineurin inhibitors; IM, intramuscular; NA, not available.

Our case series demonstrates that tralokinumab is effective in treating atopic and non-atopic CHE. Significant improvement occurred in all patients (Fig. 1). There are no previous long-term data of tralokinumab in CHE. A recent study on the effectiveness of tralokinumab in AD reported that patients with hand and feet involvement showed improved responses. ³ Interim analysis from an ongoing phase 3 clinical trial of tralokinumab in AD on hands has demonstrated a positive readout at 16 weeks. ⁴ Additionally, tralokinumab was found to be particularly effective in subsets of AD patients with head and neck dermatitis. ⁵ Gori et al reported the usefulness of tralokinumab in AD patients unresponsive to dupilumab and the JAKi upadacitinib. ⁶ Although our study is limited by a small number of patients, it was noteworthy that the response to tralokinumab was maintained over a long period of time.

Figure 1.

(a) Hand Eczema Severity Index (HECSI) scores of 6 patients over 1 year (Mean ± SD). (b) Patient 6 with mixed pattern very severe CHE at baseline and (c) after 14 months on tralokinumab treatment. (d) Patient 4 with hyperkeratotic CHE and pulpitis at baseline and (e) at 9 months on tralokinumab treatment.

In conclusion, our case series highlights 2 important points. First, tralokinumab could be an important tool in the armamentarium of CHE treatment in patients who have failed conventional topical or systemic treatments, including dupilumab and JAKis. Second, tralokinumab also appears to be a good alternative for the treatment of AD in difficult-to-treat areas, such as hands and feet. Further large-scale, long-term studies on tralokinumab use in CHE are necessary to complement our findings and further our understanding.