Tralokinumab for Chronic Hand Eczema: A 52 Week Observational Case Series

BACKGROUND: Chronic hand eczema (CHE) is a multifactorial inflammatory skin disorder with substantial impact on quality of life and work productivity. Systemic treatment options are limited, and published evidence on the use of tralokinumab, an interleukin-13-targeted monoclonal antibody approved for atopic dermatitis, in CHE is limited. OBJECTIVES: To evaluate the effectiveness and safety of tralokinumab in adults with moderate-to-severe CHE refractory to topical therapy in an observational setting. METHODS: We conducted a retrospective observational study at a tertiary dermatology center. Adults with moderate-to-severe CHE, refractory to high-potency topical corticosteroids and/or calcineurin inhibitors, received subcutaneous tralokinumab (600 mg initial dose, then 300 mg every 2 weeks). Concomitant topical therapy was allowed. Disease severity was assessed using the Hand Eczema Severity Index (HECSI) at baseline and weeks 4, 16, 32, and 52. Responses were assessed achieving HECSI-50, HECSI-75, HECSI-90, and complete clearance (HECSI-100). Data on demographics, disease duration, clinical and etiological subtypes, safety, and response after dose adjustment were collected. RESULTS: Sixteen patients (8 men, 8 women; mean age 56.5 years) were included. Baseline mean HECSI was 120.3. By week 52, 100% achieved HECSI-75, 92.3% HECSI-90, and 53.8% HECSI-100. Dose adjustment to 300 mg every 4 weeks was feasible in 62.5% with maintenance of clinical response. No serious adverse events occurred. CONCLUSIONS: Tralokinumab appears associated with clinically meaningful improvement and is well tolerated in severe CHE refractory to topical therapy, including hyperkeratotic and non-atopic forms. Response rates and maintenance after dose adjustment suggest its potential role in CHE management.