Delgocitinib 2% cream: a promising FDA-approved therapy for moderate-to-severe chronic hand eczema

Delgocitinib 2% cream (Anzupgo®) is the first U.S. FDA-approved topical Janus kinase (JAK) inhibitor for moderate-to-severe chronic hand eczema (CHE) in adults unresponsive to or unsuitable for topical corticosteroids. CHE is a multifactorial condition with significant quality-of-life impact and limited effective treatment options. Delgocitinib non-selectively inhibits JAK1, JAK2, JAK3, and TYK2, suppressing inflammatory cytokines including IFN-γ, IL-4, IL-13, IL-17A, and IL-22. Phase III randomized, double-blind, vehicle-controlled trials demonstrated a treatment success rate of up to 37.7% and a ≥4-point reduction in Hand Eczema Symptom Diary (HESD) scores after twice-daily application for 16 weeks. The cream formulation minimizes systemic risks associated with oral JAK inhibitors while providing targeted, topical relief. Adverse events are generally mild, including application site reactions, nasopharyngitis, and headache, with caution advised in pregnancy, lactation, chronic infection, and immunosuppression. Delgocitinib offers a novel, effective, and safer alternative in CHE management, warranting further research on pediatric use, long-term outcomes, and cost-effectiveness.