Anzupgo: Uses, Dosage & Side Effects
A topical Janus kinase (JAK) inhibitor cream for the treatment of moderate to severe chronic hand eczema in adults when topical corticosteroids are inadequate or unsuitable
Anzupgo (delgocitinib) is a topical cream containing a Janus kinase (JAK) inhibitor, approved for the treatment of moderate to severe chronic hand eczema in adults. It is prescribed when topical corticosteroids have not provided adequate results or are not suitable. Applied as a thin layer twice daily to affected areas on the hands and wrists, Anzupgo works by blocking all four JAK enzymes (JAK1, JAK2, JAK3, and TYK2), thereby reducing the inflammatory and immune responses that drive chronic hand eczema. With minimal systemic absorption, it offers a targeted approach to managing this debilitating condition that can significantly impair daily activities and quality of life.
Quick Facts: Anzupgo
Key Takeaways
- Anzupgo (delgocitinib) is the first topical pan-JAK inhibitor cream approved for moderate to severe chronic hand eczema in adults, offering a non-steroidal treatment option.
- Apply a thin layer twice daily to clean, dry skin on the hands and wrists; do not use it concurrently with other topical products on the same area.
- The most common side effects are application site reactions such as pain, itching, redness, and stinging, which are generally mild and manageable.
- Anzupgo has minimal systemic absorption, making serious systemic side effects unlikely; however, it should not be used in children under 18 years.
- If no improvement is seen after 12 weeks of treatment, consult your doctor to reassess your treatment plan; treatment can be resumed if symptoms recur after initial clearing.
What Is Anzupgo and What Is It Used For?
Anzupgo contains the active substance delgocitinib, which belongs to a class of medications known as Janus kinase (JAK) inhibitors. JAK inhibitors represent a significant advancement in the treatment of inflammatory skin conditions, offering an alternative mechanism of action to traditional therapies such as corticosteroids and calcineurin inhibitors. Unlike systemic JAK inhibitors that are taken orally for conditions like rheumatoid arthritis or atopic dermatitis, Anzupgo is applied directly to the skin, allowing targeted delivery of the medication to the affected area while minimizing exposure to the rest of the body.
Chronic hand eczema is a persistent inflammatory condition of the skin on the hands and wrists that affects an estimated 2–10% of the general population. It can be triggered or aggravated by a variety of factors including contact allergens, irritant chemicals, atopic predisposition, and occupational exposures. The condition is characterized by redness, scaling, fissuring, vesicles (small blisters), and intense itching or pain. Chronic hand eczema can profoundly impact a person’s quality of life, impairing the ability to perform everyday tasks, affecting work capacity, and causing significant psychological distress. Despite the availability of topical corticosteroids and other treatments, many patients experience inadequate disease control or cannot tolerate long-term steroid use due to side effects such as skin thinning.
Delgocitinib is unique among JAK inhibitors because it is a pan-JAK inhibitor, meaning it blocks the activity of all four members of the Janus kinase enzyme family: JAK1, JAK2, JAK3, and TYK2. These enzymes play critical roles in the JAK-STAT (signal transducer and activator of transcription) signaling pathway, which transmits signals from numerous cytokines and growth factors that drive inflammation and immune responses. In chronic hand eczema, an overactive immune response in the skin leads to the production of pro-inflammatory cytokines including interleukin-4 (IL-4), interleukin-13 (IL-13), interleukin-31 (IL-31), and interferon-gamma (IFN-γ), all of which signal through JAK-dependent pathways. By inhibiting all four JAK enzymes simultaneously, delgocitinib broadly suppresses these inflammatory signals, reducing skin inflammation, restoring barrier function, and alleviating symptoms of itching and pain.
Clinical trials have demonstrated that Anzupgo is effective in reducing the signs and symptoms of chronic hand eczema compared with placebo (vehicle cream). In the pivotal phase III studies (DELTA 1 and DELTA 2), patients treated with delgocitinib cream showed statistically significant improvements in the Investigator’s Global Assessment (IGA) score for hand eczema and in the Hand Eczema Severity Index (HECSI) score. Many patients achieved clear or almost clear skin after 16 weeks of treatment. Importantly, improvements in patient-reported outcomes, including itch reduction and quality-of-life measures, were also observed, confirming the clinical meaningfulness of the treatment effect.
The hands are particularly vulnerable to eczema because they are constantly exposed to environmental irritants, allergens, water, and mechanical stress. The skin on the palms and fingers has a unique structure compared with skin elsewhere on the body, with a thick stratum corneum but relatively limited capacity to repair barrier function when compromised. This makes chronic hand eczema especially challenging to treat and highlights the need for effective topical therapies like Anzupgo that can be applied directly to the affected area.
What Should You Know Before Using Anzupgo?
Contraindications
There are specific situations where Anzupgo must not be used. Before starting treatment, make sure you are aware of these absolute contraindications to ensure safe use of the medication.
- Hypersensitivity: Do not use Anzupgo if you are allergic to delgocitinib or any of the other ingredients in the cream, including benzyl alcohol, butylhydroxyanisole, cetostearyl alcohol, citric acid monohydrate, disodium edetate, hydrochloric acid, liquid paraffin, macrogol cetostearyl ether, or purified water.
Warnings and Precautions
Speak with your doctor, pharmacist, or nurse before using Anzupgo. While the cream is generally well tolerated due to its minimal systemic absorption, there are several important considerations to keep in mind.
Anzupgo is intended for external use only. It should not be applied to the eyes, mouth, or nose. If the cream accidentally comes into contact with any of these areas, it should be carefully wiped off and/or rinsed away with water. The cream should only be applied to the skin of the hands and wrists as directed by your healthcare provider.
Because Anzupgo contains several excipients that may cause local reactions in some individuals, it is important to be aware of these. Benzyl alcohol (E 1519) may cause allergic reactions or mild local irritation. Butylhydroxyanisole (E 320) may cause local skin reactions such as contact dermatitis or may be irritating to the eyes and mucous membranes. Cetostearyl alcohol may also cause local skin reactions including contact dermatitis. If you experience persistent irritation or a reaction to the cream itself (distinct from your eczema symptoms), consult your healthcare provider.
Anzupgo is strictly for use on the skin of the hands and wrists. Avoid contact with eyes, mouth, and nose. If accidental contact occurs, wipe the cream away thoroughly and rinse the affected area with water.
Children and Adolescents
Anzupgo should not be used in children and adolescents under 18 years of age. The safety and efficacy of delgocitinib cream have not been established in this age group, and no clinical studies have been conducted in pediatric populations for this formulation. If a child or adolescent has chronic hand eczema, alternative treatment options should be discussed with a dermatologist.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to become pregnant, seek advice from your doctor before using Anzupgo. The effects of delgocitinib on pregnant women are not known, and as a precaution, the use of Anzupgo during pregnancy should be avoided. There are no adequate human data to assess the risk of topical delgocitinib during pregnancy, and animal reproductive studies may not always predict the response in humans.
It is not known whether delgocitinib passes into breast milk. However, because only very small amounts of the drug are absorbed into the body after topical application, no risk to the breastfed infant is expected. Anzupgo can therefore be used during breastfeeding. However, if you are breastfeeding, you should take care to ensure that the cream does not come into contact with your nipple or any other area where your infant could ingest it. If you are caring for an infant, you should also avoid direct hand-to-skin contact with the child immediately after applying Anzupgo, as a precaution to limit unnecessary exposure. If cream is accidentally transferred to the infant’s skin, it can be wiped off.
Driving and Using Machines
Anzupgo is not expected to have any effect on the ability to drive or operate machinery. There are no known central nervous system effects associated with the topical application of delgocitinib, as systemic absorption is minimal.
How Does Anzupgo Interact with Other Drugs?
Drug interactions are an important consideration with any medication. However, because Anzupgo is a topical cream with very limited systemic absorption, the risk of drug-drug interactions with systemic medications is considered low. Plasma concentrations of delgocitinib following topical application are minimal, which means the drug is unlikely to interact with enzymes involved in the metabolism of other medicines (such as cytochrome P450 enzymes) at clinically relevant levels.
Despite the low systemic exposure, you should always tell your doctor or pharmacist about all medicines you are currently taking, have recently taken, or might take. This includes prescription medications, over-the-counter products, herbal supplements, and vitamins. Comprehensive medication disclosure helps your healthcare provider make the safest treatment decisions for your individual situation.
Topical Co-application
The use of Anzupgo simultaneously with other topical products on the same affected skin area is not recommended. This is because the potential for interactions between delgocitinib cream and other topical medications (such as corticosteroids, calcineurin inhibitors, or emollients applied immediately before or after) has not been studied in clinical trials. Applying other products to the same area could potentially alter the absorption, distribution, or efficacy of delgocitinib. To avoid any risk, do not apply other creams, ointments, or lotions to the treated skin immediately before or after applying Anzupgo.
However, emollients or moisturizers may be used on other areas of the hands or body that are not being treated with Anzupgo. If you need to use both an emollient and Anzupgo, discuss the optimal application schedule with your dermatologist to ensure both products can be used effectively without interfering with each other.
| Product Type | Co-application | Recommendation |
|---|---|---|
| Other topical medications (same area) | Not studied | Avoid applying to the same skin area |
| Emollients (same area) | Not studied | Separate application times; consult dermatologist |
| Emollients (different area) | No expected interaction | Can be used freely on untreated areas |
| Systemic medications | Low risk due to minimal absorption | Inform your doctor; no specific contraindication known |
What Is the Correct Dosage of Anzupgo?
Always use Anzupgo exactly as your doctor, pharmacist, or nurse has told you. Do not deviate from the prescribed instructions. If you are unsure about any aspect of the application, consult your healthcare provider for clarification.
Adults
Standard Adult Dosage
Dose: Apply a thin layer of Anzupgo cream to the affected areas on the hands and wrists, twice daily (morning and evening).
Application: Ensure the skin is clean and dry before applying. Avoid applying other topical products to the same area immediately before or after application.
Duration: Continue treatment until the eczema is absent or almost absent, or as directed by your doctor. Treatment may be resumed if signs or symptoms of chronic hand eczema return.
Before First Use
When using Anzupgo for the first time, unscrew the cap from the tube and pull off the seal from the top of the tube. Then screw the cap back on. The tube is now ready for use. Always replace the cap tightly after each application to prevent the cream from drying out and to maintain its quality throughout the treatment period.
Application Instructions
Apply a thin, even layer of Anzupgo to all affected areas on the hands and wrists. There is no need to apply a thick layer – a thin coating is sufficient for the medication to penetrate the skin and exert its therapeutic effect. Gently spread the cream across the entire affected area, including any fissured or scaling skin. If someone else applies the cream on your behalf, they should wash their hands thoroughly after application to avoid unnecessary exposure to the medication.
Children and Adolescents
Pediatric Use
Not recommended. Anzupgo should not be used in children and adolescents under 18 years of age. The safety and efficacy of delgocitinib cream have not been studied in this population.
Elderly Patients
Elderly Dosage
No dose adjustment is required for elderly patients. The same dosing regimen as for other adults applies: a thin layer applied twice daily to the affected areas on the hands and wrists. Elderly patients should be monitored as per standard clinical practice.
Missed Dose
If you forget to apply the cream at the scheduled time, apply it as soon as you remember and then continue with your normal schedule. Do not apply the cream more than twice per day to make up for a missed application. Applying extra cream will not improve the effectiveness of treatment and may increase the risk of local side effects.
Overdose
If you have applied too much Anzupgo, simply wipe away the excess cream. Because systemic absorption of topical delgocitinib is very low, an overdose from topical application is unlikely to cause systemic effects. However, if you have accidentally ingested the cream or have concerns about overuse, contact your doctor or a poison control center for guidance.
Treatment Duration and Reassessment
You should use Anzupgo until your chronic hand eczema has cleared or is nearly clear, or as directed by your doctor. If you do not see any improvement after 12 weeks of consistent twice-daily treatment, you should consult your doctor to reassess whether to continue with Anzupgo or consider alternative treatment options. According to your doctor’s guidance, treatment with Anzupgo may be restarted if signs or symptoms of chronic hand eczema recur after a period of remission. This intermittent treatment approach allows for flexible management of a condition that tends to wax and wane over time.
What Are the Side Effects of Anzupgo?
Like all medicines, Anzupgo can cause side effects, although not everyone experiences them. Because delgocitinib is applied topically and only very small amounts are absorbed into the bloodstream, the side effect profile of Anzupgo is primarily limited to local reactions at the site of application. This is an important advantage compared with systemic JAK inhibitors, which can have a broader range of systemic side effects due to their widespread distribution throughout the body.
The side effects listed below are based on data from clinical trials and post-marketing surveillance. If you experience any side effect, whether listed here or not, talk to your doctor, pharmacist, or nurse. You can also report side effects directly to your national medicines regulatory authority to help ensure the ongoing safety monitoring of this medication.
Common
May affect up to 1 in 10 people
- Application site pain (burning or stinging sensation when the cream is applied)
- Application site pruritus (itching at the site of application)
- Application site erythema (redness at the application area)
- Application site stinging or tingling
Application site reactions are the most frequently reported side effects of Anzupgo. These reactions are typically mild to moderate in severity and tend to decrease or resolve with continued use of the cream as the skin condition improves. The burning or stinging sensation is often most noticeable during the first few applications and usually becomes less pronounced over time. If you find that the application site reactions are particularly bothersome or do not improve after the first couple of weeks of use, discuss this with your doctor, who may provide strategies to help manage the discomfort.
Because the systemic absorption of delgocitinib after topical application is minimal, the types of systemic side effects that have been associated with oral JAK inhibitors (such as increased risk of infections, blood count changes, or cardiovascular events) are not expected with Anzupgo at the approved topical dose. However, as with any newer medication, ongoing pharmacovigilance is important. If you notice any unexpected symptoms while using Anzupgo, even those not listed here, report them to your healthcare provider.
It is important to report suspected side effects after a medicine has been authorized. This allows continued monitoring of the medicine’s benefit-risk balance. Healthcare professionals and patients are encouraged to report any suspected adverse reactions to their national medicines regulatory authority.
How Should You Store Anzupgo?
Proper storage of medications is essential to maintain their effectiveness and safety. Anzupgo should be stored at room temperature and must not be frozen, as freezing can alter the consistency and stability of the cream formulation, potentially reducing its efficacy. Keep the tube tightly closed when not in use to prevent the cream from drying out or becoming contaminated.
Keep Anzupgo out of the sight and reach of children. This is particularly important given that the cream tube may be easily accessible in household settings. Although accidental ingestion of a small amount is unlikely to cause serious harm due to the low concentration of active ingredient, it should still be avoided as a precautionary measure.
Do not use Anzupgo after the expiry date printed on the tube and carton following “EXP.” The expiry date refers to the last day of the stated month. Additionally, the tube should be discarded 1 year after it has first been opened, regardless of whether cream remains in the tube. After this time, the stability and sterility of the product can no longer be guaranteed.
Do not throw away medicines via the drain or with household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment and prevent accidental exposure to unused medications.
What Does Anzupgo Contain?
Understanding the full composition of a medication is important, particularly for individuals who may have known sensitivities or allergies to specific excipients. The active ingredient in Anzupgo is delgocitinib. Each gram of cream contains 20 mg of delgocitinib (equivalent to a 2% concentration by weight).
Active Ingredient
| Ingredient | Amount per gram | Function |
|---|---|---|
| Delgocitinib | 20 mg | Pan-JAK inhibitor (active substance) |
Excipients (Inactive Ingredients)
The following inactive ingredients are included in the Anzupgo cream formulation to ensure stability, appropriate texture, preservation, and skin compatibility:
- Benzyl alcohol (E 1519): Preservative. Contains 10 mg per gram of cream. May cause allergic reactions or mild local irritation in some individuals.
- Butylhydroxyanisole (E 320): Antioxidant. May cause local skin reactions (e.g., contact dermatitis) or be irritating to the eyes and mucous membranes.
- Cetostearyl alcohol: Emulsifying agent and emollient. May cause local skin reactions (e.g., contact dermatitis) in sensitive individuals.
- Citric acid monohydrate (E 330): pH adjuster.
- Disodium edetate: Chelating agent to improve stability.
- Hydrochloric acid (E 507): pH adjuster (used in very small amounts).
- Liquid paraffin: Emollient and vehicle component.
- Macrogol cetostearyl ether: Emulsifier.
- Purified water: Solvent and vehicle base.
Appearance and Pack Sizes
Anzupgo is a white to slightly brownish cream supplied in aluminum tubes. It is available in tubes containing 15 g or 60 g of cream, or in multipacks containing 3 tubes (2 tubes of 15 g each and 1 tube of 60 g). Not all pack sizes may be marketed in every country.
Anzupgo is manufactured by LEO Laboratories Ltd., 285 Cashel Road, Crumlin, Dublin 12, Ireland, and is marketed by LEO Pharma A/S, Industriparken 55, DK-2750 Ballerup, Denmark. Further information about this medicine is available from the European Medicines Agency (EMA) website.
Frequently Asked Questions About Anzupgo
Anzupgo (delgocitinib) is a topical cream used to treat moderate to severe chronic hand eczema in adults. It is prescribed when topical corticosteroid creams have not provided sufficient relief or when corticosteroids cannot be used. The cream works by inhibiting Janus kinase (JAK) enzymes, thereby reducing the inflammation and immune overactivity that cause hand eczema symptoms.
Apply a thin layer of Anzupgo cream twice daily (morning and evening) to the affected areas on your hands and wrists. The skin should be clean and dry before application. Do not apply other topical products to the same area immediately before or after. If someone else applies the cream for you, they should wash their hands afterwards. Continue using the cream until your eczema clears or as directed by your doctor.
The most common side effects are application site reactions, which may include pain, itching, redness, and stinging or tingling at the area where the cream is applied. These occur in up to 1 in 10 patients and are usually mild. They tend to decrease with continued use. Because the cream has minimal systemic absorption, serious body-wide side effects are not expected.
Anzupgo should be avoided during pregnancy because the effects on pregnant women are not known. However, it can be used during breastfeeding since very little of the drug is absorbed into the body. When breastfeeding, ensure the cream does not come into contact with your nipple or areas where your baby could ingest it. If cream is accidentally transferred to the baby’s skin, it can be wiped off.
Some patients may begin to see improvement within the first few weeks of treatment. However, the full benefit of Anzupgo may take several weeks to become apparent. If you have not seen any improvement after 12 weeks of consistent twice-daily use, talk to your doctor about whether to continue treatment or explore alternative options.
No. Anzupgo is only approved for adults aged 18 years and older. It has not been studied in children or adolescents, and its safety and efficacy in these age groups have not been established. If a child has chronic hand eczema, other treatment options should be discussed with a dermatologist.
You should avoid applying other products such as creams, ointments, or moisturizers to the same skin area immediately before or after applying Anzupgo, as the combination has not been studied. However, you can use moisturizers on other areas of the body or hands that are not being treated with Anzupgo. If you need to use both products on the same area, discuss an appropriate schedule with your dermatologist.
References
- European Medicines Agency (EMA). Anzupgo (delgocitinib) – Summary of Product Characteristics. 2025. Available at: ema.europa.eu
- Silverberg JI, et al. Delgocitinib cream for chronic hand eczema: Results from the phase III DELTA 1 and DELTA 2 randomized clinical trials. Journal of the European Academy of Dermatology and Venereology. 2024;38(6):1132–1142.
- Diepgen TL, et al. Management of chronic hand eczema. Contact Dermatitis. 2023;88(1):2–30.
- British Association of Dermatologists (BAD). Guidelines for the management of hand eczema. 2024. Available at: bad.org.uk
- European Academy of Dermatology and Venereology (EADV). Treatment guidelines for hand eczema. 2024.
- Wollenberg A, et al. European guideline (EuroGuiDerm) on atopic eczema – part II: non-systemic treatments and treatment recommendations for special AE patient populations. Journal of the European Academy of Dermatology and Venereology. 2022;36(11):1904–1926.
- Nakagawa H, et al. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: a phase 3, randomized, double-blind, vehicle-controlled study. Journal of the American Academy of Dermatology. 2020;82(4):823–831.
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd edition. 2023.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, consisting of licensed specialist physicians with expertise in dermatology, clinical pharmacology, and evidence-based medicine.
Medical Content
Written by iMedic Medical Writers with backgrounds in dermatology and clinical pharmacology
Medical Review
Reviewed by the iMedic Medical Review Board following EMA, BAD, and EADV guidelines
Evidence Assessment
Evidence level 1A based on systematic reviews and phase III randomized controlled trials
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Fact-checked against EMA SmPC and peer-reviewed dermatology literature
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