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慢性手部湿疹（CHE）作为一种常见的、令人困扰的皮肤疾病，以其迁延难愈、反复发作、影响美观及生活质量的特点，给患者带来了显著的身心负担。其复杂的病因学、多变的临床表现以及对外用治疗反应不佳的特性，使得系统性治疗在CHE的管理中扮演着日益重要的角色。在刚刚结束的EADV 2026年会上，“Chronic hand eczema”专场中，Kare Steinar Tveit教授分享了“Systemic treatments”的主题报告，深入剖析了当前CHE系统性治疗的研究进展、临床证据以及面临的挑战，为临床医生提供了宝贵的循证医学指导和治疗策略思考。本文将基于该报告的核心内容，系统梳理CHE系统性治疗领域的新进展，以期为临床实践提供参考。 01 慢性手部湿疹：认识其复杂性与治疗困境 报告首先强调了理解CHE复杂性对制定有效治疗方案的基础性作用。CHE并非单一疾病实体，而是一个涵盖了多种病因和临床表现的异质性疾病。 ✅ 病因学的多元性：CHE的成因复杂，包括变应性接触性皮炎（ACD）、刺激性接触性皮炎（ICD）、蛋白接触性皮炎、特应性手部湿疹等多种亚型。值得注意的是，临床上“混合型”CHE极为常见，患者可能同时存在多种致病因素，且这些因素可能随时间演变。这意味着，仅仅针对单一“主诊断”进行治疗往往是不够的，更需要全面评估并分类影响患者的各种贡献因素。 ✅ 临床表现的多样性：CHE的皮损形态多样，常见的包括急性湿疹、角化过度型、急性复发性水疱、指尖皮炎、钱币状湿疹等。这些形态学表现与特定的病因并非一一对应，同一患者可能同时存在多种形态。例如，角化过度性皮损不一定意味着病因是角化异常或银屑病样改变，水疱性皮损也不一定就是汗疱疹。这种形态与病因的非完全一致性，增加了诊断和治疗的复杂性。 ✅ 诊断与分类的重要性与局限性：2022年发布的欧洲指南中提出的分类系统，根据病因和形态学将CHE分为不同的亚型，旨在为治疗决策提供起点。然而，报告也指出，这种分类并非绝对，不同亚型常常重叠，且可能随病程变化。尽管如此，对CHE进行细致的分类和评估，仍然是管理过程的“出发点”，可以指导初步的治疗形式选择，并有助于识别可能从特定治疗中获益的患者群体。 ✅ 治疗挑战与未满足的需求：对于中重度或对常规外用治疗（如糖皮质激素、钙调神经磷酸酶抑制剂）反应不佳的CHE患者，存在显著的未满足治疗需求。临床控制往往难以实现，复发率高。CHE的慢性性质意味着需要长期管理策略。报告强调，我们需要更有效的系统性治疗手段，特别是对于那些外用治疗无法控制、严重影响功能和生活质量的患者。 02 系统性治疗策略的演进：经典药物 面对CHE的挑战，系统性治疗的选择正在不断扩展和优化。报告回顾并比较了当前可用于CHE系统性治疗的各类药物及其临床证据。 阿维A 作为一种维A酸类药物，阿维A在治疗角化过度性、裂隙性CHE中显示出明确的应用价值。报告引用了一项回顾性研究，针对角化过度性/裂隙性CHE患者的对比数据显示：阿维A在6个月时达到44%的清除或接近清除率，同期甲氨蝶呤（MTX）的比例为0%；12个月时阿维A的清除或接近清除率达到100%，而MTX仅为40%。但该研究MTX平均剂量仅为12.5mg，远低于临床常规使用剂量，本身存在明显的设计缺陷，数据不能直接代表足量MTX的真实疗效。 甲氨蝶呤 报告重点讨论了MTX不同给药途径的生物利用度差异。口服给药时MTX在胃肠道的吸收存在明显个体变异：在7.5mg/㎡-80mg/㎡体表面积的低剂量给药区间，口服MTX的平均生物利用度约为70%。而皮下、静脉、肌肉三种注射给药途径的生物利用度相近，均可接近100%。此外，口服MTX的生物利用度在剂量超过15mg之后就会进入平台停滞状态，继续加量也无法提升药物暴露量；但皮下注射MTX的生物利用度可以伴随剂量升高持续稳步上升。 阿利维A酸 阿利维A酸是目前唯一获批用于重度CHE的口服维A酸类药物。一项大型Ⅲ期随机对照试验（n=1032）证实，每日30mg治疗可使47.7%的患者达到PGA“清除或几乎清除”，显著优于安慰剂（16.6%，P<0.001），且疗效呈剂量依赖性。针对角化过度型、指尖型等难治亚型，30mg剂量的应答优势最为突出，应答率分别可达49%和44%。真实世界回顾性研究进一步显示，其12个月累积治疗成功率可达72.7%，优于环孢素对照队列（64.7%）——值得指出的是，后者入组时基线病情更重。 此外，双向序贯治疗数据证实环孢素与阿利维A酸跨作用机制转换使用时，单药治疗失效后切换另一类方案均可实现IGA评分的显著下降，二者不存在交叉耐药，为CHE全周期治疗提供了灵活的序贯选择空间。 DELTA FORCE 24 是一项为期24周的头对头Ⅲ期试验，直接对比了口服阿利维A酸与外用2%德戈替尼乳膏的疗效。结果显示第12周口服阿利维A酸组的手部湿疹严重指数（HECSI）评分较基线平均下降51.5%，IGA应答率为17%，自治疗第1周开始口服阿利维A酸的疗效就持续低于外用JAK抑制剂组，全程未实现疗效反超，这也为临床重度CHE的阶梯化治疗选择提供了分层依据。 03 靶向治疗新纪元：生物制剂与JAK抑制剂 随着对CHE免疫病理机制的深入解析，靶向特定细胞因子的生物制剂与小分子JAK抑制剂相继进入临床视野，为传统治疗应答不佳的患者开辟了全新路径。报告从靶向药物的头对头比较、单药循证深化及跨方案疗效特征解析三个层面，勾勒出靶向治疗的现状与选择逻辑。 1）阿布昔替尼 vs. 度普利尤单抗：头对头研究中的疗效差异 JADE DARE Ⅲ期研究的事后亚组分析为合并中重度特应性皮炎（AD）的CHE人群提供了首项靶向药物头对头疗效对比。该分析从727例中重度AD成年患者中筛选出373例基线手部湿疹IGA≥3分的受试者，随机接受阿布昔替尼200mg每日口服或度普利尤单抗300mg每两周皮下注射，均联合外用糖皮质激素。两组在疾病严重度、皮损特征及亚型构成上均衡可比——特应性手部湿疹占比87%–90%，刺激性接触性皮炎约占13%，贴近真实世界临床分布。 以手部湿疹IGA清除/几乎清除且较基线改善≥2分为终点，阿布昔替尼组展现出更快、更强的应答曲线：第2周应答率22%，第4周升至51%，第26周达75%；度普利尤单抗组同期分别为14%、24%和62%。该事后分析为合并中重度特应性皮炎的CHE人群的系统治疗提供了参考。 2）度普利尤单抗：从特应性手足皮炎到难治CHE的循证拓展 度普利尤单抗靶向IL-4Rα，阻断IL-4/IL-13信号通路。一项纳入133例12岁及以上特应性手足皮炎患者的Ⅲ期双盲安慰剂对照试验证实，16周时度普利尤单抗组HF-IGA清除/几乎清除率达40.3%，手足峰值瘙痒NRS改善≥4分的比例达52.2%，均显著优于安慰剂（16.7%与13.6%），实现皮损清除与瘙痒症状的双重获益。 针对阿利维A酸应答不足或不耐受的重度CHE人群，一项探索性研究（n=29，基线手部湿疹严重指数均值>85）显示，度普利尤单抗治疗后HESCI 50及75应答率均达95%，HESCI 90应答率达70%，获益覆盖刺激性接触性皮炎和特应性手部湿疹亚组。进一步的临床观察表明，在既往无特应性皮炎病史、已接受至少2种系统治疗失败的角化过度型手部湿疹人群中，多数经16周治疗可达到皮损完全清除，仅合并职业接触性皮炎者表现为显著部分缓解。上述证据为系统治疗失败后的序贯升级提供了高质量依据，完善了CHE的阶梯治疗路径。 3）靶向药物间的间接比较：应答深度与速度的双维视角 在单项研究之外，报告进一步解读了一项覆盖主流靶向药物的CHE 16周疗效信号间接对比分析，从“应答深度”与“应答速度”两个维度刻画不同药物的差异化特征。该分析提示，CHE系统治疗决策不应仅聚焦远期应答率，而应将疗效幅度与症状控制时间并列为核心考量。兼顾这两重需求的个体化选药，才能最大程度减轻皮损疼痛及手部活动受限对患者生存质量的侵蚀，为这一难治性疾病的分层治疗提供关键性的循证框架。 04 治疗决策与组合策略的思考 面对众多系统性治疗选择，如何为CHE患者制定个体化的治疗方案？报告提出了以下思考： 1）安全与监测驱动的简化临床决策矩阵 报告明确指出，CHE系统性治疗方案的选择，安全性与监测负担的权重往往和疗效同等重要。基于8类常用系统性药物的5维安全属性评分，可生成临床易用的简化安全/监测矩阵，评分规则为1=低限制/低负担、2=中度/场景化限制、3=高限制/明确禁忌，为临床快速评估方案可行性提供直观参考： ✅ 维A酸类：整体为中等负担，需重点关注生育力影响、血脂监测及黏膜皮肤耐受性问题，妊娠维度为明确高禁忌。 ✅ 传统免疫抑制剂（环孢素、甲氨蝶呤、硫唑嘌呤、吗替麦考酚酯）：是所有类别里实验室监测工作量最大、安全负担最重的品类，除起效速度维度外，其余安全相关维度几乎全部为高限制等级。 ✅ 生物制剂：以度普利尤单抗、IL-13单抗为代表，整体安全负担最低，实验室监测、感染风险、妊娠风险维度均为低/中低负担，是监测流程最简单的类别，但需要额外关注潜在的眼部不良反应。 ✅ JAK抑制剂：起效速度为低负担（起效很快），但妊娠维度为明确高禁忌，长期安全性仍存在中高程度的不确定性，需要持续随访观察。 2）联合治疗的探索前景 报告围绕CHE的联合用药可能性，梳理了4类当前临床正在探索的联用方案，分享了基于自身长期临床实践的一手经验： ✅ 生物制剂+甲氨蝶呤（MTX）：作者已在特应性皮炎人群中，使用度普利尤单抗、Lebrikizumab这类生物制剂长达5年以上，积累了长期安全使用的经验。 ✅ 生物制剂+阿维A/阿利维A酸：作者已在银屑病患者人群中，积累了阿维A联合TNF-α抑制剂/IL-23抑制剂多年的长期使用经验，安全性与疗效均得到临床验证。 ✅ 生物制剂+JAK抑制剂：作者已在特应性皮炎人群中，联用阿布昔替尼与来瑞奇珠单抗，反馈得到了“效果极佳、安全性优异”的临床结果。 ✅ JAK抑制剂+阿利维A酸：作者目前尚未有该组合的实际使用经验，重点关注两类药物均可能带来胆固醇升高的叠加风险，对该组合的实际疗效与安全性抱有强烈的探索兴趣。 所有这些联合方案目前均缺乏大规模随机对照循证医学证据支持，报告也明确提出，现有经验多来自其他皮肤病种的长期临床观察，期待更多在CHE人群中的探索数据落地，进一步拓展重症难治患者的治疗选择。 结 语 EADV 2026关于CHE系统性治疗的报告，系统梳理了从传统免疫抑制剂到新兴生物制剂和JAK抑制剂的最新循证医学证据，深入分析了各种疗法的优势、局限性和适用场景。随着对CHE发病机制认识的不断深入和新型靶向药物的不断涌现，CHE的系统性治疗将朝着更精准、更有效、更安全的方向发展，最终为广大CHE患者带来福音。 参考来源： [1]Presented at the European Academy of Dermatology & Venereology Conference; Thursday, 01 October 2026; D2T05.2D 免责声明 本微信文章中的信息仅供向医疗卫生专业人士提供科学信息，不可直接作为决策内容，得码学苑不对任何主体因使用本文内容而导致的任何损失承担责任。以上内容如涉版权请联系删除。

ROSEMONT, Ill., Oct. 20, 2026 /PRNewswire/ -- Over 3 million people have been diagnosed with hidradenitis suppurativa (HS) in the United States and today, the American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have published the first-ever joint guidelines for the management and care of HS. HS is a skin condition that causes painful lumps deep in the skin, typically in areas of the body where skin rubs together like armpits, inner thighs, and the groin. Early diagnosis of HS is critical as it is often confused with acne or infection, causing people to go years without an accurate diagnosis. A board-certified dermatologist can both identify HS and screen for the medical and psychiatric conditions that often accompany it, giving patients access to comprehensive, individualized care sooner. "While hidradenitis suppurativa is a chronic condition, its painful symptoms are highly treatable," said AAD President and board-certified dermatologist Murad Alam, MD, MSCI, MBA, FAAD. "For millions of people with HS, dermatologists provide more than just a diagnosis. They provide expert, comprehensive care that allows patients to have a better quality of life." Compiled by a work group of 13 experts, including 12 board-certified dermatologists, the newly released guidelines, published in the Journal of the American Academy of Dermatology (JAAD), include 37 evidence-based recommendations designed to treat chronic HS disease and acute HS flares. "These guidelines establish an evidence-based standard of care for HS, giving patients, dermatologists, and payers a shared roadmap for what high-quality HS care looks like," said board-certified dermatologist Haley B. Naik, MD, FAAD, co-chair of the Hidradenitis Suppurativa Guideline Work Group and president of HSF. "Every person living with HS deserves care that meets this standard." The largest barrier to impactful HS care is step therapy, an insurance requirement for patients to try insurer-designated treatments before coverage is approved for the dermatologist-prescribed preferred medication. Evidence does not support the use of step therapy in HS care as it delays access to appropriate treatment. Strong recommendations of care Strong recommendations imply that treatment benefits clearly outweigh risks and burdens. These recommendations apply to most patients in most circumstances. Biologics (adalimumab, bimekizumab, infliximab, and secukinumab), injectable treatments that target the immune system, are strongly recommended for individuals with moderate-to-severe HS. These treatments are shown to reduce the number of abscesses and nodules by at least half, without any new abscess or tunnel development. Abscesses are painful lumps that grow, join together, and fill with fluid. Tunnels are hollow channels that form under the skin. Conditional recommendations of care Conditional recommendations imply that treatment benefits are closely balanced with risks and burdens. These recommendations apply to most patients, but the best course depends on what matters most to each individual, including their tolerance for side effects, treatment goals, and day-to-day circumstances. Topical therapies (clindamycin, resorcinol, and ruxolitinib) are applied to the skin to reduce abscesses and the severity of symptoms. Systemic antibiotics (doxycycline, tetracycline, clindamycin in combination with rifampin, and ertapenem) work throughout the body to decrease severity of symptoms and improve quality of life. Hormone therapy (spironolactone) is taken by mouth to decrease severity. Systemic therapies (upadacitinib and short-term systemic steroids) are taken by mouth and work throughout the body for individuals with moderate-to-severe HS to reduce disease activity and pain. Continuing injectable biologics (adalimumab) is recommended for individuals with moderate-to-severe HS undergoing surgery. In-office procedures can be especially helpful if abscesses and tunnels have formed in the skin, including: Deroofing, a minor treatment to open and flatten the tunnels under the skin. This treats recurrent or persistently bothersome HS lesions, or bumps, spots, or growths. Incision and drainage to treat painful abscesses. Surgical removal of an area of affected skin for abscesses or tunnels that persist or continue to come back. Laser hair removal for fewer flares. Botulinum toxin to reduce flares. Intralesional triamcinolone (a steroid injection) to treat painful, flaring bumps. Conditional recommendations were made against the use of oral retinoids (acitretin and isotretinoin), certain biologics (etanercept, guselkumab, risankizumab, and vilobelimab), systemic therapies (avacopan, and methotrexate and azathioprine as primary treatments), and radiotherapy for pediatric and adolescent HS patients. In addition, there is insufficient evidence to support oral contraceptive pills or finasteride (hair loss medication) for HS management. Supportive management While HS therapies may reduce pain, they don't always achieve adequate pain relief. Supportive pain management is a conditional recommendation that helps manage sudden pain, consistent pain, and pain that does not improve after treatment and pain relief therapies. Treatments to manage sudden pain include warm or cool compresses, topical lidocaine (a local anesthetic), acetaminophen (a pain reliever), nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen, steroid injections, incision and drainage, and short-term steroids that work throughout the body. Opioids can be used if the pain doesn't decrease through other treatments. Long-lasting pain can be managed with serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, psychotherapy, proper wound care, and nerve pain medications such as gabapentin and pregabalin. There is insufficient evidence to support weight reduction and GLP-1 usage for HS treatment. There is also insufficient evidence that specific diet plans — intermittent fasting, the Mediterranean diet, the yeast exclusion diet, and the dairy-free diet — help manage HS. However, a heart-healthy diet of fruits and vegetables, whole grains, healthy fats, and lean proteins remains important for reducing heart and diabetes risk for individuals with HS. Complementary medicine Lifestyle changes and supplements can also help manage the pain and discomfort from HS. A conditional recommendation was made for quitting tobacco, which can improve an individual's response to treatments aimed at addressing the disease itself. Conditional recommendations were made for complementary and alternative medicine, including vitamin D supplements for individuals with deficiencies, and zinc supplements. These supplements, taken under a doctor's supervision, may reduce lumps and tunnels and relieve pain. "Untreated HS can have a serious impact on your health and well-being. It can cause scarring, wounds that limit your mobility, and intense pain. It also often happens in combination with other medical and psychiatric conditions, with this increasing its overall toll on patients," said Dr. Alam. "Whether you've been diagnosed with HS or suspect you may have it, please take the time to see a board-certified dermatologist to have it expertly assessed, consider your options, and find the best plan for you." To find a board-certified dermatologist in your area, visit aad.org/findaderm. Resources Hidradenitis Suppurativa: Overview (AAD) How to Treat HS (HSF) Find an HS Provider (HSF) About the AAD Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 21,500 physicians worldwide, the AAD is committed to advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education and research in dermatology; and supporting and enhancing patient care because skin, hair, and nail conditions can have a serious impact on your health and well-being. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow @AADskin on Facebook, TikTok, Pinterest, and YouTube, and @AADskin1 on Instagram. About the Hidradenitis Suppurativa Foundation Since its founding in 2005, the Hidradenitis Suppurativa Foundation has fostered and encouraged worldwide research by developing and supporting an interdisciplinary family of scientists and physicians devoted to studying Hidradenitis Suppurativa, in order to deliver more effective forms of treatment and preventative measures to those with this common, debilitating, and eminently chronic disease. HSF is a 501(c)(3) dedicated to improving the lives of people affected by Hidradenitis Suppurativa (HS) through research, education, and advocacy. Explore their resources for patients, clinicians, and investigators at hs-foundation.org, and follow @hsforg on Instagram and YouTube, and @HidradenitisSuppurativaFoundation on Facebook and LinkedIn. SOURCE American Academy of Dermatology 21% more press release views with Request a Demo