Hyperkeratotic Hand Eczema Successfully Treated with Dupilumab Therapy: A Series of 3 Case Reports

<ns3:p>Background Hyperkeratotic hand eczema (HHE) is a distinct subtype of hand eczema characterized by sharply defined regions of hyperkeratosis on the palms and occasionally the fingers, with an unclear classification, a pathogenesis, and treatment. Dupilumab is an IgG4 monoclonal antibody used in the treatment of moderate-to-severe atopic eczema with highly satisfactory results; nevertheless, its role in HHE is inadequately characterized. This report offers the first assessment of dupilumab’s effectiveness in managing HHE in the Middle East and North Africa (MENA) region. Methods This case report presents three patients with HHE treated with dupilumab over a four-week period. Results All patients exhibited the characteristic symptoms of HHE, including sharply defined hyperkeratosis on the palms and fingers accompanied by painful fissures, mild itching, and minimal/absent redness. None showcased current atopic dermatitis or had a family history of atopy, palmoplantar keratoderma, or psoriasis. Previous treatments encompassed systemic and topical corticosteroids, acitretin, and biologics, yielding limited efficacy. Skin biopsies indicated the presence of spongiotic eczematous dermatitis, characterized by compact orthokeratosis, parakeratosis, epidermal acanthosis with mild spongiosis, and a mild lymphoid infiltrate devoid of eosinophils. Throughout dupilumab’s four-week course, all patients exhibited significant improvements, with no adverse drug reactions reported. Conclusion This report indicates that dupilumab may serve as an effective and safe treatment option for HHE and constitutes one of the first assessments of its effectiveness in (MENA) region.</ns3:p>