D-CARE (Delgocitinib-Chronic hAnd Eczema Response Evaluation): A Retrospective, Multicenter, Real-World Study of Patients with Chronic Hand Eczema (CHE) Treated with Delgocitinib 2% Cream-Temporal Analysis of Symptom and Clinical Sign Response

Introduction: Chronic hand eczema (CHE) is a frequent and often refractory inflammatory skin disease with a substantial impact on quality of life. Delgocitinib 2% cream has demonstrated efficacy in phase 3 trials, but real-world evidence remains limited. This study evaluated its effectiveness and the temporal dynamics of clinical and symptomatic response in patients with CHE. Methods: This multicenter, retrospective observational study included 58 adults with CHE treated with delgocitinib 2% cream and followed for 16 weeks. Clinical severity and patient-reported outcomes were assessed at baseline, week 4, and week 16. Changes in the Hand Eczema Severity Index (HECSI), global assessment scores, pruritus, pain, and quality of life were analyzed, together with the evolution of individual HECSI components across anatomical regions. Results: All clinical and patient-reported outcomes improved significantly during follow-up (all p < 0.001). Mean HECSI decreased from 71.5 ± 29.2 at baseline to 19.5 ± 15.1 at week 4 and 6.8 ± 8.9 at week 16. Pruritus and pain both showed marked reductions during follow-up. At week 4, mean vesicle and edema scores were 0.0-0.1 across anatomical regions, while desquamation remained 1.0 ± 1.1 at the fingertips and fingers; at week 16, fissure scores were 0.2 and 0.3 and desquamation scores were 0.4 and 0.3 at the fingertips and fingers, respectively. Quality of life also improved substantially. Two patients (3.4%) experienced adverse events leading to treatment discontinuation. Conclusions: Delgocitinib 2% cream showed rapid and clinically meaningful real-world effectiveness in CHE. Inflammatory signs improved earlier than chronic structural features such as fissures and desquamation. These differential response kinetics may help clinicians interpret early partial responses and counsel patients regarding expected treatment timelines.