Efficacy and safety of dupilumab in chronic hand eczema: a systematic review

Chronic hand eczema (CHE) significantly impacts patients’ quality of life and remains challenging to manage, especially in topical steroid-refractory cases. Dupilumab, a monoclonal antibody that targets the interleukin-4 receptor alpha, has demonstrated efficacy in moderate-to-severe atopic dermatitis and various other type 2 inflammatory conditions. This systematic review evaluates the effectiveness and safety of dupilumab in the treatment of CHE. A comprehensive search was performed of the Ovid MEDLINE and Embase databases from their inception until March 2024, identifying 20 studies, including randomized controlled trials (RCTs), retrospective and prospective studies, and case reports, involving 366 participants aged 12 years and older with CHE treated with dupilumab. Effectiveness was assessed using the Hand Eczema Severity Index (HECSI), Physician Global Assessment (PGA), and Dermatology Quality of Life Index (DQLI), while safety was evaluated through reported adverse events (AE). Dupilumab consistently improved CHE symptoms, with 40.3% of RCT participants achieving Hand and Foot Investigator’s Global Assessment 0/1 by week 16, and 90% achieving HECSI-75 among treated groups. Improvements were observed across various CHE subtypes, including atopic, irritant contact, and allergic contact dermatitis. Dupilumab was generally well-tolerated, with a 1.64% discontinuation rate due to minor AE, such as conjunctivitis. While herpes was reported in RCTs, no AE were reported in case studies. Dupilumab appears to be a promising treatment option for CHE, offering significant efficacy and a favorable safety profile. However, further research is needed to explore its long-term effectiveness, optimal dosing strategies, and cost-effectiveness.