Chronic eczema

Chronic hand eczema is estimated to affect close to 5% of adults and can cause pain, itching, redness, blistering and swelling of the hands and wrists, among other symptoms, per Leo Pharma. More than 90% of dermatology clinicians surveyed by Leo Pharma say their patients with moderate to severe chronic hand eczema (CHE) experience negative impacts from the condition on their physical and emotional well-being.The finding is part of the second swath of results from a survey commissioned by Leo and conducted by Ipsos at the start of this year. Nearly 200 U.S. dermatology providers were included, comprising doctors, nurse practitioners and physician assistants.The first set of findings, released in early March, focused on the healthcare professionals’ desire for specific treatments for CHE. No such med has yet been approved in the U.S.—limiting derms to prescribe only general eczema treatments for CHE, which is a distinct condition from eczema—though Leo’s delgocitinib cream, a topical JAK inhibitor dubbed Anzupgo, is currently under review by the FDA, with a decision expected in the second half of 2025.The latest survey results, out Tuesday, delve into the effects of the skin condition on patients. Of the clinicians queried, 93% said they believe CHE impacts their patients’ emotional health, with about the same number saying their CHE patients feel self-conscious about the condition.Meanwhile, 92% said it inhibits their patients’ ability to perform certain daily activities. One such activity cited by respondents was typing at a computer. The condition may therefore negatively impact a person’s workplace performance; indeed, 86% of derms said CHE has created struggles at work for their patients.Those struggles could in turn affect an individual’s finances and overall career path, with about half of those surveyed agreeing that CHE impacts their patients’ financial situations and has caused their careers to stall. In a statement in Leo’s Tuesday announcement of the survey results, a CHE patient noted that the condition’s potential impact on her financial security is the “hardest thing” about it.“It’s difficult to work full time because I’m self-conscious about my hands and live in fear of having a flare and needing to call in sick or having to mask my pain while interacting with customers or co-workers,” she said.Beyond workplace struggles, nearly three-quarters of the HCPs surveyed said CHE has an impact on their patients’ friendships and romantic and familial relationships, with 68% agreeing the condition may prevent intimacy in romantic relationships.CHE is estimated to affect close to 5% of adults and can cause pain, itching, redness, blistering and swelling of the hands and wrists, among other symptoms, per Leo.“Given that we use our hands for almost everything we do, chronic hand eczema can significantly disrupt patients' daily routines,” Raj Chovatiya, M.D., Ph.D., founder and director of the Center for Medical Dermatology + Immunology Research, said in a statement. “Many of my patients struggle with simple household tasks like washing dishes, cleaning or even using a keyboard for work. The toll on their self-confidence and mental well-being can be overwhelming.”

58岁的李阿姨（化名）十年前发现大腿内侧有一片暗红色斑块，瘙痒难忍，抓挠后脱屑，医生诊断为“慢性湿疹”，激素药膏一用就是八年。可斑块逐渐蔓延全身，皮肤像“干枯树皮”般增厚，部分区域溃烂流脓，散发出腐臭味。家人发现她颈部和腋窝冒出核桃大的肿块，硬如岩石，这才慌忙转诊至皮肤科。活检报告触目惊心：真皮层大量异型T细胞浸润，形成“亲表皮现象”（肿瘤细胞像蚂蚁钻入表皮），免疫组化显示CD3+、CD4+、CD8-，T细胞受体基因重排阳性，确诊为蕈样肉芽肿（MF）——皮肤T细胞淋巴瘤（CTCL）中最常见的“隐形杀手”！临床表现及分型CTCL是一种源于皮肤的非霍奇金淋巴瘤，年发病率低，约0.36～0.90/10万，已被列为罕见病。CTCL有多种亚型，最常见的是MF，占60%以上，其他常见亚型包括原发性皮肤CD30+淋巴增殖性疾病（pcALCL、LyP）、Sézary综合征（SS）等。CTCL的分期可以根据疾病的累及范围分为早期和进展期。早期MF的表现为皮肤红斑或斑块，可能持续多年而没有明显进展。进展期MF则表现为全身多发皮肤结节或肿块，并可能出现红皮病，进一步累及外周血、骨髓及内脏。而SS作为CTCL的一种侵袭性亚型，其典型表现为红皮病、大范围淋巴结肿大，并且外周血中有大量Sézary细胞。诊断CTCL的诊断主要依靠临床表现、组织病理、免疫表型及TCR克隆性重排检测。皮损组织的病理和免疫组化是金标准。MF的病理特征包括表皮萎缩、亲上皮肿瘤细胞分布及Pautrier微脓肿，免疫表型为CD2、CD3、CD5、CD4、TCRβ阳性，CD8和TCRγ阴性。Sézary细胞强表达CD27，可与良性红皮病鉴别，CD158k作为新标志物在Sézary细胞中的敏感性和特异性较高。外周血受累的患者可通过流式细胞术分析免疫表型。TCR重排辅助诊断，但早期疾病灵敏度较低。高通量测序优于RT-PCR，但两者准确度相似。CTCL的早期诊断仍困难，MF患者平均确诊时间为3～7年。治疗CTCL的治疗包括局部治疗和系统治疗。常用的局部治疗有氮疥凝胶、光疗和糖皮质激素。系统治疗包括化疗、维氨蝶呤、免疫抑制药物以及靶向治疗，如西达本胺、莫格利珠单抗和贝沙罗汀。免疫治疗（如PD-1/PD-L1抑制剂）在晚期MF/SS患者中有效。自体或同种异体造血干细胞移植可考虑用于复发或难治患者，但复发率高。组合治疗，如ECP与贝沙罗汀联合，正进行临床探索。pcALCL和LyP等类型的CTCL治疗包括局部治疗、靶向治疗和化疗，治疗方案根据病情不同有所调整。整体治疗正向个性化和靶向化发展。参考资料：[1]张炎,刘洁,张薇.皮肤T细胞淋巴瘤的治疗进展[J].临床皮肤科杂志,2024,53(01):48-52.DOI:10.16761/j.cnki.1000-4963.2024.01.014.[2]晋红中,唐珂韵.皮肤T细胞淋巴瘤的诊治进展[J].皮肤性病诊疗学杂志,2023,30(05):391-401.[3] WILLEMZE R, CERRONI L, KEMPF W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas[]. Blood, 2019, 133(16):1703-1714.来源 | 梅斯医学编辑 | wanny神经系统罕见病交流群↓点击下方“阅读原文”，下载梅斯医学APP吧！

Leo Pharma announced in September that the FDA had accepted its application for its delgocitinib cream as a treatment for adults with chronic hand eczema (CHE), with a decision expected in the second half of this year. An approval would make the topical JAK inhibitor the first therapeutic specifically greenlighted for CHE in the U.S. A new survey commissioned by Leo Pharma confirms there’s plenty of room in the market for its chronic hand eczema treatment Anzupgo, which is currently under review by the FDA.The survey, conducted by Ipsos, queried nearly 200 dermatology providers, including doctors, nurse practitioners and physician assistants, at the start of this year, according to a Wednesday press release. It focused on their experiences with chronic hand eczema (CHE), which, in the absence of any specific FDA-approved therapeutics, is typically treated with a range of eczema meds.Just over half of those surveyed agreed that current treatments for moderate to severe eczema, also known as atopic dermatitis, don’t sufficiently translate as treatments for moderate to severe CHE.A majority of the healthcare professionals noted that their CHE patients are typically on three or four separate medications to manage the condition, and a quarter of clinicians cited significant issues with patient adherence.Likely due to the lack of CHE-specific treatments, almost two-thirds of the survey respondents said CHE is more frustrating to manage than other chronic skin conditions. More than 60% said their patients with moderate to severe CHE rack up three or four office visits per year, and 27% reported closer to five or six office visits per year for those patients.On top of the treatment difficulties, 65% of the derms said that there’s a lack of education around CHE as a separate condition from atopic dermatitis.Leo is therefore hoping the survey results and a planned symposium this week ahead of the American Academy of Dermatology’s annual meeting will help improve awareness among healthcare providers about CHE, which is estimated to affect nearly 16 million people in the U.S. alone, per the release.“It’s only through better understanding of this complex disease that we can help improve the standard of care in medical dermatology and ultimately improve patients’ quality of life,” Robert Spurr, Leo’s president of the North America region, said in a statement. Leo announced in September that the FDA had accepted its application for its delgocitinib cream as a treatment for adults with CHE, with a decision expected in the second half of this year. An approval would make the topical JAK inhibitor the first therapeutic specifically greenlit for CHE in the U.S.; the cream has already been approved in Europe, where it’s now sold as Anzupgo.Shortly after the regulatory update last fall, Leo unveiled an unbranded healthcare provider-focused campaign to boost awareness of CHE. The “Talk to the Hand” initiative features educational resources about CHE symptoms and risk factors to improve diagnoses plus information about available treatments and patient testimonials to drill down the importance of accurate diagnosis and adequate treatment.Meanwhile, the company plans to release a second swath of results from the Ipsos survey in the coming months focusing specifically on healthcare providers’ assessments of how CHE affects their patients’ daily lives.