Limited Use Note(s)

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Reason For Use CodeClinical Criteria
442For adult patients with severe (see note 1 below) chronic (see note 2 below) hand eczema AND unresponsive to an 8 week course of high potency topical corticosteroids. 1. Severe defined based on the Physician Global Assessment (PGA), including: - At least one of the following cardinal features present at baseline as moderate or severe: erythema, scaling, hyperkeratosis/lichenification; and - one of the following features present as severe: vesiculation, edema, fissures, pruritus/pain; and - with an area of greater than 30% of affected hand surface 2. Chronic defined as: - persists for greater than 3 months; OR - reoccurs greater than or equal to 2 times within 12 months
LU Authorization Period: 1 year