NEW YORK — August 26, 2026 — For the first time, physicians in the United States can prescribe a medication approved specifically to treat chronic hand eczema. Delgocitinib cream, sold as Anzupgo, became available to prescribe in the US this month, following FDA approval in July of last year.
Until now there was nothing. Every treatment used for chronic hand eczema was borrowed from somewhere else in dermatology — topical steroids intended for other conditions, off-label systemic drugs, phototherapy adapted from psoriasis protocols. Delgocitinib is the first product studied in this disease, in this location, and approved for it.
Dr. Dennis Porto, a double board-certified dermatologist and Mohs micrographic surgeon, argues that the gap being closed here has been badly underestimated for a long time.
“Hand eczema is dismissed as a nuisance because it is small in surface area. That is exactly the wrong way to measure it. I scrub my hands dozens of times a day — if mine cracked and bled, I could not operate. For a hairdresser, a chef, a nurse, a mechanic, this is not a cosmetic problem. It is a question of whether they can keep doing their job.”
Why hands are their own problem
Eczema on the hands behaves differently from eczema anywhere else, for reasons that are mostly mechanical. The skin of the palms is far thicker than skin elsewhere, which makes topical medication harder to get through. Hands are washed constantly, stripping the barrier lipids that other body sites are allowed to keep. They are in near-continuous contact with soaps, solvents, food, water, metals, and gloves. And unlike a patch on the trunk, they cannot be rested, covered, or left alone to heal.
The condition is also several conditions wearing one name. Chronic hand eczema covers irritant contact dermatitis, allergic contact dermatitis, atopic hand eczema, and vesicular or dyshidrotic forms, and a given patient often has more than one at once.
“The single most common mistake is treating the inflammation without ever identifying what is driving it. If someone is allergic to a preservative in the soap at work, no cream on earth is going to outrun that exposure. Patch testing is not an optional extra in this disease. It is frequently the whole answer.”
What delgocitinib is
It is a topical pan-JAK inhibitor, blocking JAK1, JAK2, JAK3, and TYK2 — four signaling proteins that relay inflammatory messages inside cells. Interrupting them dampens the inflammatory cascade driving the disease. Because it is applied to the skin rather than swallowed, systemic exposure is low, which is the central design argument for using this class topically rather than orally.
It is approved for adults with moderate-to-severe chronic hand eczema who have not responded adequately to topical corticosteroids, or for whom steroids are not advisable. That second phrase matters more than it appears: the palms and backs of the hands tolerate long-term steroid use poorly, and many patients with a chronic condition reach the limit of what steroids can safely do long before their disease is controlled.
What the trials showed, honestly
Approval rested on two identically designed phase 3 trials, DELTA 1 and DELTA 2, published in The Lancet, enrolling 960 adults treated twice daily for sixteen weeks against a vehicle cream.
On the primary endpoint — clear or almost clear skin with at least a two-point improvement — 20% of treated patients succeeded versus 10% on vehicle in DELTA 1, and 29% versus 7% in DELTA 2.
“Those numbers deserve to be read carefully rather than celebrated. Roughly a quarter of patients reached clear or almost clear. That means most did not. I would rather a patient hear that from me than discover it themselves at week sixteen.”
The symptom data is arguably the more meaningful half, because it maps onto what patients actually complain of. Around 49% of treated patients reported a substantial reduction in pain, against 28% and 23% on vehicle. Itch improved in about 47%, against 23% and 20%. Pain and itch are what wake people at night and what stop them working.
Side effects occurred at rates similar to the vehicle cream in both trials, and an open-label extension following patients out to nine months showed no increase in adverse events, with roughly 30% clear or almost clear at that point.
“A treatment that halves someone’s pain without clearing their skin is still a treatment worth having, particularly when the alternative was nothing designed for this disease at all. Complete clearance is not the only outcome that counts.”
Where it fits, and what to ask
This is not a first-line therapy. It is for people who have already tried topical steroids without adequate response, or who cannot use them safely. The prescribing information carries the warnings applied across the JAK class, including risks relating to infection and non-melanoma skin cancer, which is worth a specific conversation for anyone with a history of skin cancer or significant immunosuppression.
“If you have had hand eczema for years and were told there was nothing specifically approved for it, that sentence is now out of date. It is a reasonable thing to raise. Bring what you have already tried, because that history determines whether you even qualify.”
The unglamorous measures still matter alongside it, and skipping them undermines everything else: identifying and removing the trigger, gloves for wet work, fragrance-free emollients applied far more often than feels reasonable, and patch testing where allergic contact dermatitis is plausible.
“Every patient I have seen with stubborn hand eczema has been told to moisturize, and almost none were told how often. It is not twice a day. It is every time your hands get wet, all day, for months. That alone changes outcomes.”
Dr. Dennis Porto, MD, MPH, FAAD is a double board-certified dermatologist and Mohs micrographic surgeon, and a Clinical Assistant Professor at Mount Sinai, where he teaches skin cancer surgery to dermatology resident physicians. He treats patients virtually through SkinCare.MD, including eczema and the other conditions covered by his practice.
Journalists and researchers are welcome to quote from this article. Please attribute quotations to Dennis A. Porto, MD, MPH, FAAD, and cite www.skincare.md as the source. Dr. Porto is available for comment on dermatology and skin cancer topics; interview requests may be directed through the contact information at skincare.md.