When to arrange an assessment
Consider assessment if：
- Eczema is not controlled despite regular emollients and over-the-counter treatment
- Itch is disturbing sleep — yours or your child's
- Flares are recurring every few weeks
- You are using topical steroids frequently and want a plan that reduces them
- You are worried about steroid side effects and have been avoiding treatment as a result
- Skin is weeping, crusting, painful, or suddenly worse — this may be infection
- Hand eczema is affecting your work
- Adult-onset eczema, or a rash that has changed character
- You would like to know whether phototherapy or newer systemic treatments are appropriate for you
- The condition is affecting mood, confidence, school or work
⚠️ Seek urgent medical attention for widespread painful clustered blisters or punched-out erosions with fever — possible eczema herpeticum.
Prognosis: what to expect
In children. The majority improve substantially with age. Roughly 60% of childhood cases clear or become much milder by adolescence. However, "clear" is not quite the right word — the tendency to dry, sensitive skin usually persists lifelong, and hand eczema in adulthood is common, particularly in occupations involving wet work.
Predictors of a more persistent course: early onset with severe disease, widespread involvement in childhood, filaggrin mutation, strong family history, high total IgE, coexisting asthma or allergic rhinitis, and adult-onset disease.
In adults. Adult atopic dermatitis tends to be more persistent and to run a chronic relapsing course. It is, however, highly treatable — and the systemic options now available mean severe adult eczema is no longer the intractable problem it was even ten years ago.
Realistic expectations
- The goal is long-term control, not cure. Framed honestly, that means: clear or nearly clear skin most of the time, sleeping through the night, and flares that are infrequent, mild and quickly settled.
- Emollients and a maintenance routine continue even when the skin looks normal. This is the price of stability and it is not negotiable.
- Flares will happen. A written flare plan — what to apply, how much, for how long, and when to seek help — converts a crisis into a manageable event.
- Improvement follows a sawtooth pattern, not a straight line. Judge progress over months.
- Post-inflammatory pigmentation fades over months once inflammation is controlled.
- With modern treatment, the majority of patients with even severe disease can expect substantial improvement.
Living with atopic dermatitis in Hong Kong
Local conditions create specific problems worth planning around.
Humidity and heat. Sweat is a genuine trigger. Shower promptly after sweating, use lighter emollient formulations from May to September, and choose loose cotton clothing. This is one of the few situations where advice imported from European guidelines needs local adjustment.
Air conditioning. Offices, MTR and homes are dehumidifying for much of the year, and air-conditioned dryness is a major driver of winter-pattern flares even in a subtropical climate. A humidifier at the bedside is often more useful than another cream.
Dust mite. Hong Kong's humidity supports high dust mite levels. Mite-proof mattress and pillow covers and hot washing of bedding are reasonable for patients with demonstrated sensitisation. Blanket avoidance measures for everyone are not evidence-based.
Housing. Compact, poorly ventilated flats can mean high humidity and mould alongside dust mite. Worth asking about.
School and work. Children with disturbed sleep underperform, and this is frequently attributed to the child rather than to the eczema. A letter to a school explaining the condition and permitting emollient application during the day is often genuinely useful.
Traditional Chinese medicine. Many patients use TCM alongside conventional treatment, and there is no need to be adversarial about it. Two practical points: some oral Chinese herbal preparations have been associated with liver toxicity, and some topical products have been found to contain undeclared steroids. Tell whoever is treating you what else you are using — the risk comes from the combination being unknown, not from the choice itself.
Step 1: Topical anti-inflammatory treatment
Step 2: Proactive maintenance (most often skipped)
Step 3: NB-UVB Phototherapy
Step 4: Conventional systemic treatment
Step 5: Biologics and oral JAK inhibitors
Reference:
- 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.
- 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.
- 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.
- Wollenberg A, Kinberger M, Arents B, et al. EuroGuiDerm guideline on atopic eczema. J Eur Acad Dermatol Venereol. (most recent update).
- National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. CG57.
- Leung R, Wong G, Lau J, et al. Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 1997.
- Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong: ISAAC Study from 1995 to 2015. — source of the 21-year local trend data.
- Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
- 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.
- 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.
- Sanofi. Press release: decision not to submit amlitelimab in atopic dermatitis for global regulatory reviews. Paris, 24 July 2026.
- 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.
- 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.
- Hong Kong Drug Office, Department of Health — verify local registration status of every systemic agent named.
