Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?

Given the cost of delgocitinib, I have difficulty justifying it unless there has been an inadequate response to high-potency topical steroids and calcineurin inhibitors. I expect there to be significant improvement with these, and consider an inadequate response to be the inability to decrease to a ...

I see delgocitinib fitting in early in the algorithm after emollients, barrier repair, and avoidance strategies; particularly for patients who either fail a brief potent steroid course or who are not good candidates for ongoing steroid use, whether it be preference or previous experience. It can als...

Try using high-potency topical steroids - I typically do a regimen of 5 days on, two days off, repeat as needed. If that completely relieves the hand eczema, I'm comfortable with that regimen long term. If it doesn't completely relieve the hand eczema, Anzupgo should be the next step.