Expert Consensus on Advanced Topical Nonsteroidal Therapies for Chronic Hand Eczema

BACKGROUND: Chronic hand eczema (CHE) is a common, heterogeneous inflammatory skin disease associated with substantial symptom burden, impaired hand function, reduced quality of life, and work-related disability. Despite its clinical impact, evidence-based guidance for long-term, steroid-sparing topical management has been limited. OBJECTIVE: To develop expert consensus statements on the role of advanced topical nonsteroidal therapies in CHE management. METHODS: A panel of seven dermatologists with expertise in CHE conducted a structured literature review, prioritizing CHE-specific trials when available. Evidence was evaluated using the Strength of Recommendation Taxonomy (SORT). Draft statements were refined through a Delphi consensus process, with consensus predefined as ≥75% agreement. RESULTS: The panel reached consensus on six statements addressing advanced topical nonsteroidal therapies in CHE. These agents were recognized as important steroid-sparing options appropriate for long-term use. Delgocitinib cream is currently the only topical therapy with CHE-specific regulatory approval and is considered an appropriate first-line advanced topical treatment. Clinical trial data show that advanced topical nonsteroidal therapies provide rapid and sustained improvements in erythema, scaling, fissuring, pruritus, and pain. Delgocitinib demonstrated sustained improvements in patient-reported outcomes and superior health-related quality-of-life benefits compared with oral alitretinoin in severe CHE. Treatment has also been associated with improved work productivity and daily functioning. These therapies have favorable safety profiles, with adverse events largely limited to local reactions, minimal systemic exposure, and no requirement for routine laboratory monitoring. Other topical nonsteroidal agents may have a role in selected patients, although CHE-specific data remain limited. CONCLUSION: This consensus provides practical guidance supporting individualized, steroid-sparing CHE management while identifying areas for future research.  .