Topical JAK Inhibitors for Chronic Hand Eczema: A New Direction in Treatment

Bramley Pharmacy – Clinical Eczema Assessment in Ealing

Chronic hand eczema is one of the most persistent, painful and disruptive forms of eczema. When the hands become repeatedly inflamed, cracked, itchy or sore, it impacts everyday life, work, sleep and confidence. Many adults find that even with correct use of emollients and steroid creams, symptoms keep returning.

A significant development in dermatology has been the introduction of a topical Janus Kinase (JAK) inhibitor, authorised in the UK as Anzupgo (delgocitinib). This prescription-only medicine is licensed solely for moderate to severe chronic hand eczema in adults when standard topical treatments have not worked well enough or are unsuitable.

Bramley Pharmacy does not promote prescription-only medicines. The purpose of this article is to provide neutral, educational information about this class of treatment and to highlight the importance of clinical assessment for anyone struggling with persistent hand eczema.

Understanding chronic hand eczema

Chronic hand eczema (CHE) refers to eczema affecting the hands that:

• lasts longer than three months

• relapses frequently

• becomes resistant to standard therapies

Hands are exposed to irritants and allergens throughout the day, making them more prone to damage and inflammation. CHE may involve a mixture of:

• atopic eczema

• irritant dermatitis

• allergic contact dermatitis

• dyshidrotic eczema (pompholyx)

Accurate diagnosis is crucial, as each pattern behaves differently and may require a tailored treatment plan.

How Anzupgo (delgocitinib) and other topical JAK inhibitors work

Topical JAK inhibitors represent a new mechanism of action in eczema management. Unlike steroid creams, which suppress inflammation at the skin’s surface, delgocitinib works inside skin cells by blocking the JAK-STAT signalling pathway.

This pathway is triggered by key eczema-driving cytokines such as:

• IL-4

• IL-13

• IL-22

• IL-31

• Interferons

These cytokines fuel:

• itch

• redness

• swelling

• pain

• barrier damage

By inhibiting the intracellular signals that these cytokines use, delgocitinib reduces inflammatory activity, allowing the skin barrier to repair and symptoms to improve.

Because the cream is applied directly to the hands, the medication concentrates where it is needed, with limited systemic absorption.

Benefits of topical JAK inhibition

A different option when steroids are not enough

Many adults with chronic hand eczema use steroid creams frequently but experience incomplete relief or rapid relapse. A non-steroidal option with a distinct mechanism can be valuable.

Reduction in itch and inflammation

Clinical studies show improvements in itch intensity, redness, dryness and skin cracking over the first few weeks of treatment.

Improved barrier recovery

By calming cytokine activity, the epidermis can repair more effectively, strengthening the skin’s protective function.

Potentially useful for occupational hand eczema

People exposed to water, detergents or frequent handwashing may find that standard treatments are insufficient. A different mechanism of action can offer an alternative route.

Drawbacks and limitations

Licensed only for chronic hand eczema in adults

Anzupgo is not licensed for:

• children

• facial eczema

• widespread atopic eczema

• infected eczema

Not suitable during active infection

Any bacterial, viral or fungal infection should be treated first.

Immune-pathway modification requires caution

Even with low systemic absorption, long-term effects are still being studied.

Not first-line therapy

It is considered only after appropriate use of steroid creams and emollient therapy.

Diagnosis must be accurate

Some conditions mimic hand eczema, such as psoriasis or fungal infections. Using advanced therapies without confirming the diagnosis is inappropriate.

What the clinical evidence shows

DELTA Phase III Trials

The DELTA studies evaluated delgocitinib cream in adults with moderate to severe chronic hand eczema.

Key findings across trials included:

• higher clinical response rates compared with placebo

• reductions in itch and inflammation within several weeks

• improved hand function and quality of life

• good tolerability with mainly mild local reactions

• minimal systemic absorption

These trials provided the evidence base for UK regulatory approval.

Mechanistic studies

Research confirms that JAK inhibition reduces signalling from Th2-driven cytokines implicated in eczema, helping restore barrier function and reduce symptoms.

Real-world insights

Clinicians report benefit in:

• long-standing chronic hand eczema

• cases where steroid cycles are difficult to sustain

• occupational eczema with frequent flare cycles

However, long-term safety and real-world data collection remain ongoing.

Where this fits within eczema care

A topical JAK inhibitor such as delgocitinib is positioned after:

• correct emollient use

• optimised steroid therapy

• trigger identification and avoidance

• occupational and lifestyle adjustments

It is not a first-step treatment and must be considered only after other options have been appropriately trialled.

How Bramley Pharmacy can help

Bramley Pharmacy does not advertise or dispense prescription-only medicines through public-facing promotion.
What we do offer is clinical eczema assessment, helping patients understand:

• their specific type of hand eczema

• reasons for persistent symptoms

• whether current treatment is optimised

• whether referral or patch testing is appropriate

• how to improve barrier care and flare prevention

• when advanced therapies might be considered

Proper assessment often resolves long-standing issues without needing escalated treatment.

Frequently Asked Questions

Is Anzupgo (delgocitinib) the same as a steroid cream?

No. It works inside skin cells by blocking inflammatory signalling rather than suppressing inflammation at the surface.

Can it be used on the rest of the body?

No. It is licensed only for chronic hand eczema in adults.

Is it available over the counter?

No. It is a prescription-only medicine and cannot be requested or purchased without clinical assessment.

Is it safe?

Clinical trials show it is generally well-tolerated. As with all treatments that affect immune pathways, monitoring and correct use are essential.

How quickly does it work?

Many patients experience improvements within a few weeks of regular use.

Can children or teenagers use it?

No. Its licence applies only to adults.

Is it suitable for infected eczema?

No. Any infection must be treated first.

Are there alternatives?

Yes — optimised barrier care, appropriate-strength topical steroids, avoidance of irritants and allergens, patch testing, and dermatology referral all play key roles.

Book an eczema assessment

If your hand eczema is persistent, painful or repeatedly flaring, a structured clinical review may help identify triggers and improve symptom control.

Bramley Pharmacy
261 Northfield Avenue
Ealing, W5 4UA
0208 840 4464

Appointments can also be booked through our website.