Effectiveness of oral Janus Kinase inhibitors in refractory chronic hand eczema

Abstract Background: Chronic hand eczema (CHE) is a common but challenging condition with limited effective systemic medications. Oral janus kinase (JAK) inhibitors have shown potential recently. Objectives: The objective of the study was to evaluate the efficacy of different oral JAK inhibitors in patients with refractory CHE. Methods: In this retrospective exploratory observational study, CHE patients with poor or no response to topical corticosteroids received upadacitinib, abrocitinib, or tofacitinib. Efficacy was assessed at weeks 4 and 12 using the Hand Eczema Severity Index (HECSI) and Worst Itch Numeric Rating Scale (WI-NRS). Paired t -tests and analysis of covariance were used for analysis. Results: We analyzed 32 CHE patients treated with one of the oral JAK inhibitors with well treatment efficacy. Mean HECSI decreased from 30.9 to 10.3 at week 4 and 3.5 at week 12 ( P < 0.001). At week 4, all patients achieved HECSI-50; by week 12, 90.5% reached HECSI-75. Higher baseline severity showed greater improvement at week 4 ( P = 0.041) but not at week 12 ( P = 0.055). WI-NRS improved from 5.2 to 0.4. No significant differences were observed between treatment groups after adjustment. Conclusion: Oral JAK inhibitors resulted in rapid and significant improvement in refractory CHE, including both pruritus and skin lesions. This study provides preliminary real-world observations across multiple oral JAK inhibitors in CHE, supporting their potential roles in treatment-resistant cases. However, given heterogeneous dosing and small subgroup sizes, comparative efficacy cannot be concluded.