Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2025;15(1):4685 1

Refractory Chronic Hand Eczema Responds  
to Oral Upadacitinib

Nada J. Alghamdi1, Abdullah A. Aljalfan1, Abdulmajeed S. Alharbi2,  
Omar I. Alrubaish2, Serene R. Almuhaidib3

1 Department of Dermatology, King Fahd University Hospital, Al Khobar, Saudi Arabia

2 College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia

3 Dammam Medical Complex Hospital, Dammam, Saudi Arabia

Key words: hand eczema, upadacitinib, dermatitis, jak inhibitor

Citation: Alghamdi NJ, Aljalfan AA, Alharbi AS, Alrubaish OI, Almuhaidib SR. Refractory Chronic Hand Eczema Responds to Oral 
Upadacitinib. Dermatol Pract Concept. 2025;15(1):4685. DOI: https://doi.org/10.5826/dpc.1501a4685

Accepted: October 2, 2024; Published: January 2025

Copyright: ©2024 Alghamdi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Abdullah Ali Aljalfan, MD, Department of Dermatology, King Fahd University Hospital, Address: P.O. Box 34246, 
Al Khobar, Saudi Arabia. Phone: +966558744844. E-mail: A.jalfan7@hotmail.com

Introduction

Hand dermatitis is a common inflammatory skin condition 

that greatly affects quality of life and productivity. It can be 

caused by endogenous causes like atopic dermatitis, or exoge-

nous causes like contact dermatitis either irritant or allergic [1].  

Treatment options for hand dermatitis include topical 

and oral medication, phototherapy. However, severe and 

 difficult-to-treat cases, particularly those not associated 

with atopic dermatitis, have limited treatment choices [2,3]. 

 Research is ongoing to explore the use of immunomodula-

tory drugs, like Janus Kinase (JAK) inhibitors, for chronic 

hand eczema [2].

Case Presentation

A 58-year-old woman with a history of chronic hand eczema 

was referred to our Dermatology Department due to signif-

icant deterioration of her condition. This deterioration was 

characterized by extreme pruritus and severe dryness pri-

marily on the palmar surfaces of both hands (Figure 1). The 

patient condition had worsened after the COVID-19 pan-

demic started. She sought medical intervention following the 

intense exacerbation. The patient had neither personal nor 

familial history of atopic dermatitis or other form of atopy. 

Several diagnostic procedures were done, including a patch 

test, standard laboratory tests and mycological culture were 

negative. A skin biopsy (performed outside our institution) 

revealed eczematous changes. Before coming to our clinic, 

she had been treated with a variety of topical medications, 

including topical clobetasol, topical tacrolimus, with little 

or no relief. A 3-month trial of NB-UVB phototherapy was 

conducted 3 times per week. Despite this treatment regimen, 

no alleviation of itchiness was observed, and the lesions re-

mained resilient and persistent.

Due to limited options and the unavailability of alitreti-

noin and dupilumab in our hospital, we offered conventional 

immunosuppressants (eg methotrexate, cyclosporin), but the 



2 Research Letter | Dermatol Pract Concept. 2025;15(1):4685

patient opted out. After explaining possible side effects, the 

patient agreed to start on a novel JAK inhibitor drug avail-

able in our institution. Upadacitinib 15 mg once daily was 

initiated, and a follow-up appointment was arranged after 

2 weeks. The patient exhibited substantial improvement at 

follow-up (Figure 2). No adverse effects were documented. 

Informed consent was obtained from the patient to share 

this case.

Conclusions

Hand dermatitis or hand eczema is a clinically diverse illness in 

terms of etiologies and clinical symptoms. Patients with refrac-

tory chronic hand eczema who failed multiple management 

options, as in our patient, require other options such as con-

ventional immunosuppressants (eg cyclosporin, methotrexate) 

or systemic retinoids [1-3]. Upadacitinib is an oral medication 

Figure 1. Thickening of the skin, scaling, and areas of hyperkeratosis on palmer aspect  

of both hands, prior to starting oral upadacitinib.

Figure 2. After 2 weeks of oral upadacitinib 15 mg once daily.



Research Letter | Dermatol Pract Concept. 2025;15(1):4685 3

DOI:10.4103/0019-5154.131372. PMID: 24891648. PMCID: 

PMC4037938.

2. Thyssen JP, Schuttelaar MLA, Alfonso JH, et al. Guidelines for 

 diagnosis, prevention, and treatment of hand eczema. Contact Der-

matitis. 2022;86(5):357-378. DOI:10.1111/cod.14035. PMID:  

34971008.

3. Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Derma-

tol Venereol. 2020;34 Suppl 1:13-21. DOI:10.1111/jdv.16062. 

PMID: 31860736.

4. Guttman-Yassky E, Teixeira HD, Simpson EL, et al. Once-daily 

upadacitinib versus placebo in adolescents and adults with 

 moderate-to-severe atopic dermatitis (Measure Up 1 and Mea-

sure Up 2): results from two replicate double-blind, randomised 

controlled phase 3 trials. Lancet. 2021 5;397(10290):2151-2168. 

DOI: 10.1016/S0140-6736(21)00588-2. Epub 2021 21. Erratum 

in: Lancet. 2021 Jun 5;397(10290):2150. DOI: 10.1016/S0140-

6736(21)01214-9. PMID: 34023008.

that has received approval from the FDA for the management 

of moderate- to- severe atopic dermatitis in adults and ado-

lescents aged 12 years and older. The mechanism of action of 

upadacitinib involves the inhibition of JAK [4]. This case high-

lights the efficacy of upadacitinib as a promising therapeutic 

option for refractory hand eczema. Despite multiple treatment 

trials, the patient did not achieve remission. However, the ini-

tiation of oral upadacitinib resulted in remarkable improve-

ment. Further studies are needed to determine the long-term 

efficacy and safety of upadacitinib in treating hand eczema.

References

1. Agarwal US, Besarwal RK, Gupta R, Agarwal P, Napalia S.  

Hand eczema. Indian J Dermatol. 2014;59(3):213-224.