Emerging treatments

Excimer laser

The 308-nm excimer laser also affects modulation of inflammatory cells and plays a role in the treatment of hand dermatitis.[49] However, the increased cost and time associated with excimer laser means that treatment is typically logistically difficult to prescribe when compared to phototherapy with a hand/foot narrowband ultraviolet (UVB) box.​

Alitretinoin

The retinoid alitretinoin has been extensively studied in hand dermatitis with some efficacy.[38]​ At present only limited data exists for use in dyshidrotic dermatitis, and more data is necessary before use is recommended.[50]

Dupilumab

Dupilumab, a monoclonal antibody against interleukin-4 receptor alpha, was established as a treatment for atopic dermatitis via two randomised, placebo-controlled phase 3 trials (SOLO1 and SOLO2) and is approved for this indication.[51][52]​ Its use for chronic hand eczema, including vesicular subtypes, has been studied in phase 2b and observational trials where subjects achieved clinical and symptomatic improvement.​​[53][54] There have also been published case reports and case series of successful use of dupilumab in dyshidrotic eczema.[55][56][57]​​​​​

Janus kinase (JAK) inhibitors

The small molecule JAK inhibitors encompass a class of newer topical and oral medicines directed towards the JAK/STAT signalling pathway which are implicated in several inflammatory diseases including dermatitis.[52]​ Topical JAK inhibitors such as ruxolitinib, tofacitinib, and delgocitinib have demonstrated benefit in atopic dermatitis in phase 2 and 3 trials.[58][59]​​​ Topical ruxolitinib is approved for atopic dermatitis and was studied for hand eczema.[60] The oral JAK inhibitors abrocitinib, upadacitinib, and baricitinib have randomised, controlled, clinical trial evidence for efficacy and treatment of atopic dermatitis with upadacitinib currently being studied for hand eczema.[61][62][63][64][65][66][67][68][69]​ There is a case report of treatment success with the upadacitinib for dyshidrotic eczema.[70]​​​​​​​​​​​​​​​​​​

Crisaborole

Crisaborole is a topical phosphodiesterase-4 inhibitor that is approved for atopic dermatitis, based on two large double blinded vehicle-controlled studies.[71][72] Although it has not been studied specifically in dyshidrotic eczema, it has shown some efficacy in hand dermatitis in a single institution case series.[73]​​

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