Upadacitinib useful option for managing Atopic dermatitis with concomitant hand eczema

AD and HE are prevalent inflammatory skin disorders. 50% of AD patients present with hand involvement and have a fourfold increased lifetime prevalence of HE compared to individuals without AD.

The HE subtypes are irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and protein contact dermatitis (PCD). There are limited treatment options for HE patients.

Newer AD treatments have been developed. Dupilumab is effective for treating HE in AD patients. Other recently available systemic treatments for AD include Janus Kinase (JAK)-inhibitors which could effectively treat HE irrespective of the subtype.

Daily practice data on upadacitinib's effectiveness in AD is promising, but the data is limited. Few case series and reports have been published in this context.

Considering this, Esmé Kamphuis et al with team evaluated the 16-week effectiveness and safety of upadacitinib on AD and HE in AD patients.

The study summary includes the following:

The cohort study had clinical outcomes: (at baseline week four and week 16)

          Eczema Area and Index: HECSI

          Photographic guide

          PROMs: average pruritus and pain

          Numeric Rating Scale (NRS) score

          Patient-Oriented Eczema Measure (POEM)

          Patient-Oriented Eczema

          Dermatology Life Quality Index (DLQI)

          Atopic Dermatitis Control Tool (ADCT)

         Patient Global Assessment of Disease (PGAD)

        Quality Of Life Hand Eczema Questionnaire (QOLHEQ).

• The study included 38 patients.
• Thirty-two patients had Hand Eczema.
• EASI-75 was achieved by 50.0% at week 16.
• The researchers reported 62.5% of patients with an absolute cutoff score of ≤4 on the Numeric Rating Scale (NRS), 37.5% had a Patient-Oriented Eczema Measure (POEM) of ≤7, and 59.4% of patients had ≤5 scores on the Dermatology Life Quality Index (DLQI).
• 68.8 % of patients had ADCT <7
• 53.1 % of patients had a 'good' PGAD rating.
• 59 % of patients achieved HECSI-75, and 74.1 % achieved a clear photographic guide.
• The minimally important change in QOLHEQ was achieved by 57.9%.
• Sub-analysis with concomitant irritant contact dermatitis patients showed no differences.
• No new findings in safety analysis were reported.

To conclude, Upadacitinib can be an effective treatment strategy for AD patients.

There was marked improvement of HE in patients treated with upadacitinib for AD.

Future studies are warranted to investigate the effect on the different etiological subtypes of HE.

Kamphuis, Esmé, et al. "Experiences From Daily Practice of Upadacitinib Treatment on Atopic Dermatitis With a Focus on Hand Eczema: Results From the BioDay Registry." Contact Dermatitis, Wiley, Jan. 2023. Crossref, https://doi.org/10.1111/cod.14276.