光學治療濕疹 徹底舒緩痕癢

異位性皮膚炎(濕疹): 實證治療

 

治療以階梯方式進行，而且每一級都保留下一級的基礎。潤膚劑從不停用。

階段治療適用情況
基礎治療潤膚劑、沐浴習慣、誘因迴避所有患者，任何時候
第一級治療外用類固醇；外用鈣調神經磷酸酶抑制劑輕至中度；發作期治療
第二級治療每週兩次主動維持治療；非類固醇外用藥（PDE4 抑制劑、外用 JAK、tapinarof）同一部位反覆發作
第三級治療窄頻 NB-UVB 光療外用治療控制不足的中度病情；有效的類固醇節省方案
第四級治療傳統系統性藥物：環孢素、甲氨蝶呤、硫唑嘌呤、霉酚酸酯中至重度
第五級治療生物製劑；口服 JAK 抑制劑上述治療仍未受控的中至重度
濕疹 口服 治療 香港

第四級: 傳統系統性治療

適用於上述治療仍不足夠的中重度病情，所有藥物均需基線及持續的血液監察。

  • 環孢素：起效最快，通常 2 至 6 週內即有明顯改善。因對血壓及腎功能的影響，一般作短期使用（通常不超過 6 至 12 個月）。用於挽救嚴重發作極為有效。

  • 甲氨蝶呤：起效較慢，較適合長期使用，每週一次，一般耐受良好。
  • 硫唑嘌呤：開始前須檢測 TPMT。
  • 霉酚酸酯：上述藥物不適用時的替代選擇。

 

口服類固醇需要特別警告: 它見效極快，因此十分誘人，但濕疹在停藥後往往反彈得比原先更嚴重。

***它只適合在嚴重發作時作短暫過渡，絕不應作持續治療。若患者反覆接受口服類固醇療程，這個模式本身就值得檢討。***

第一級治療: 外用抗炎治療

第二級治療: 主動維持治療(常被忽略)

第三級治療: 窄頻NB-UVB 光療

第四級治療: 傳統系統性治療

第五級治療: 生物製劑, 口服JAK抑制劑

Reference:

  1. Davis DMR, Drucker AM, Alikhan A, et al. AAD guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023.
  2. Sidbury R, Alikhan A, Bercovitch L, et al. AAD guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2023.
  3. Guidelines Development Panel of the Hong Kong College of Paediatricians. Management of Atopic Dermatitis in Children: 2020 Review. HK J Paediatr. 2021;26:42-57. — the key local reference; cite this prominently.
  4. Wollenberg A, Kinberger M, Arents B, et al. EuroGuiDerm guideline on atopic eczema. J Eur Acad Dermatol Venereol. (most recent update).
  5. National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. CG57.
  6. Leung R, Wong G, Lau J, et al. Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 1997.
  7. Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong: ISAAC Study from 1995 to 2015. — source of the 21-year local trend data.
  8. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
  9. Efficacy and Safety of Lebrikizumab in Combination With Topical Corticosteroids in Adolescents and Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial (ADhere). JAMA Dermatol.
  10. ARCADIA 1 and ARCADIA 2 — two identically designed pivotal phase III trials enrolling more than 1,700 patients, evaluating nemolizumab administered subcutaneously every four weeks versus placebo with background topical corticosteroids.
  11. Sanofi. Press release: decision not to submit amlitelimab in atopic dermatitis for global regulatory reviews. Paris, 24 July 2026.
  12. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis (SOLO 1 and SOLO 2). N Engl J Med. 2016.
  13. Chalmers JR, et al. BEEP trial: daily emollient during the first year of life for preventing atopic dermatitis. Lancet. 2020. — the negative prevention trial cited in the article.
  14. Hong Kong Drug Office, Department of Health — verify local registration status of every systemic agent named.