{"id":619,"date":"2026-08-18T17:35:51","date_gmt":"2026-08-18T09:35:51","guid":{"rendered":"https:\/\/eczema.skinmedical.com.hk\/clinical_features\/"},"modified":"2026-08-19T16:41:23","modified_gmt":"2026-08-19T08:41:23","slug":"clinical_features","status":"publish","type":"page","link":"https:\/\/eczema.skinmedical.com.hk\/en\/clinical_features\/","title":{"rendered":"Clinical Features"},"content":{"rendered":"<div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-1d7ebd15\" data-vce-do-apply=\"all el-1d7ebd15\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-66-66p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-acdb07ad\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-acdb07ad\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-acdb07ad\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-78a85e69\" data-vce-do-apply=\"all el-78a85e69\"><h2><span style=\"color: #808080;\">Eczema&nbsp;<\/span><\/h2>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-06ac29d4\" data-vce-do-apply=\"all el-06ac29d4\"><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-42b51d2e\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-42b51d2e\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-42b51d2e\"><div class=\"vce vce-separator-container vce-separator--align-center vce-separator--style-solid\" id=\"el-22ff1fbf\" data-vce-do-apply=\"margin el-22ff1fbf\"><div class=\"vce-separator vce-separator--color-bfc0c1 vce-separator--width-100 vce-separator--thickness-1\" data-vce-do-apply=\"border padding background  el-22ff1fbf\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-d7ce7784\" data-vce-do-apply=\"all el-d7ce7784\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-22-12p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-e40e6d83\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-e40e6d83\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-e40e6d83\"><div class=\"vce-single-image-container vce-single-image--align-center\"><div class=\"vce vce-single-image-wrapper\" id=\"el-5634530a\" data-vce-do-apply=\"all el-5634530a\"><figure><div class=\"vce-single-image-figure-inner\" style=\"width: 400px;\"><div class=\"vce-single-image-inner vce-single-image--absolute\" style=\"width: 100%; padding-bottom: 66.75%;\"><img loading=\"lazy\" decoding=\"async\" class=\"vce-single-image\"  width=\"400\" height=\"267\" srcset=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2024\/05\/photo-1586282091736-c2f9a8af8772-320x214.jpg 320w, https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/photo-1586282091736-c2f9a8af8772-400x267.jpg 400w\" src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/photo-1586282091736-c2f9a8af8772-400x267.jpg\" data-img-src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2024\/05\/photo-1586282091736-c2f9a8af8772.jpg\" data-attachment-id=\"312\"  alt=\"\" title=\"\" \/><\/div><\/div><figcaption hidden=\"\"><\/figcaption><\/figure><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-77-86p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last\" id=\"el-aa4b4b5c\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-aa4b4b5c\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-aa4b4b5c\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-9d287ffa\" data-vce-do-apply=\"all el-9d287ffa\"><h3><strong><span style=\"color: #756464;\"><span style=\"color: #756464;\">Atopic dermatitis: Clinical features<\/span><\/span><\/strong><\/h3><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><span style=\"font-size: 15pt;\">The <strong>core features are itch<\/strong> (essential to the diagnosis \u2014 eczema without itch is not eczema), dryness, and an age-typical distribution with a chronic relapsing course.<\/span><\/span><\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-3e2ceed2\" data-vce-do-apply=\"all el-3e2ceed2\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-120ca139\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-120ca139\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-120ca139\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-9b543de2\" data-vce-do-apply=\"all el-9b543de2\"><p><span style=\"color: #756464;\"><strong>Supporting features frequently seen<\/strong>: extra folds under the lower eyelids (Dennie-Morgan lines), darkening around the eyes, pallor around the mouth, accentuated palm creases, keratosis pilaris (\"chicken skin\" on the upper arms), white dermographism, and nipple eczema.<\/span><\/p><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><strong>The itch deserves separate attention.<\/strong> It is typically worse in the evening and at night, it disrupts sleep in both the patient and often the parents, and it drives an itch-scratch cycle that is self-sustaining. Interleukin-31 is a key mediator driving pruritus, barrier dysfunction, type 2 inflammation and fibrosis. Night-time scratching that a patient is unaware of is one of the main reasons eczema fails to settle, and it is one of the most useful things to ask about at a consultation.<\/span><\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-10 vce-row-equal-height vce-row-content--top\" id=\"el-0ec595d3\" data-vce-do-apply=\"all el-0ec595d3\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-790cd527\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-790cd527\" vce-box-shadow=\"el-790cd527\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-790cd527\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-a0619bb5\" data-vce-do-apply=\"all el-a0619bb5\"><h3>Complications to recognise<\/h3>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-ae44a2c4\" data-vce-do-apply=\"all el-ae44a2c4\"><p><span style=\"color: #756464;\"><strong>Bacterial infection.<\/strong> Weeping, honey-coloured crusting, pustules, sudden worsening, pain. Usually S. aureus.<\/span><\/p><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><strong>Eczema herpeticum.<\/strong> \u26a0\ufe0f This is an emergency. Widespread clusters of small, uniform, punched-out erosions, often with fever and feeling unwell, spreading rapidly over 24\u201348 hours. It requires same-day assessment and antiviral treatment. If this is developing, do not wait for a routine appointment \u2014 attend an emergency department.<\/span><\/p><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><strong>Molluscum contagiosum<\/strong> and viral warts, more extensive in eczematous skin.<\/span><\/p><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><strong>Sleep disturbance<\/strong>, with knock-on effects on growth in children, and on concentration and mood at any age.<\/span><\/p><p>&nbsp;<\/p><p><span style=\"color: #756464;\"><strong>Psychological impact<\/strong>. Anxiety and depression rates are elevated. In adolescents, visible facial and hand involvement is particularly damaging.<\/span><\/p><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last\" id=\"el-6e0b8cd1\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-6e0b8cd1\" vce-box-shadow=\"el-6e0b8cd1\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-6e0b8cd1\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-5b4ed37c\" data-vce-do-apply=\"all el-5b4ed37c\"><h3><span style=\"color: #756464;\">Associated conditions - the atopic march<\/span><\/h3>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-6f246e19\" data-vce-do-apply=\"all el-6f246e19\"><p><span style=\"color: #756464;\">Atopic dermatitis is often the first step in a sequence: eczema in infancy, then food allergy, then asthma, then allergic rhinitis. Roughly a third of children with atopic dermatitis go on to develop asthma, and a similar or larger proportion develop allergic rhinitis. Early treatment of atopic dermatitis is considered necessary to prevent the atopic march leading to comorbidities such as asthma and allergic rhinitis.<\/span><\/p><p><br><span style=\"color: #756464;\">Whether treating eczema well actually prevents the later conditions remains unproven \u2014 the evidence is suggestive rather than conclusive, and I would not want to overstate it. What is certain is that controlling the eczema itself is worthwhile on its own terms.<br><\/span><\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-52e5d0af\" data-vce-do-apply=\"all el-52e5d0af\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-c8d08a8e\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-c8d08a8e\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-c8d08a8e\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-e3d84074\" data-vce-do-apply=\"all el-e3d84074\"><p><span style=\"color: #756464; font-size: 12pt;\">Reference:<\/span><\/p>\r\n<ol>\r\n \t<span style=\"color: #756464; font-size: 12pt;\">\r\n<li><span style=\"color: #756464; font-size: 12pt;\">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.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">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.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">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. \u2014 the key local reference; cite this prominently.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Wollenberg A, Kinberger M, Arents B, et al. EuroGuiDerm guideline on atopic eczema. J Eur Acad Dermatol Venereol. (most recent update).<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. CG57.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Leung R, Wong G, Lau J, et al. Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 1997.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong: ISAAC Study from 1995 to 2015. \u2014 source of the 21-year local trend data.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">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.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">ARCADIA 1 and ARCADIA 2 \u2014 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.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Sanofi. Press release: decision not to submit amlitelimab in atopic dermatitis for global regulatory reviews. Paris, 24 July 2026.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">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.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Chalmers JR, et al. BEEP trial: daily emollient during the first year of life for preventing atopic dermatitis. Lancet. 2020. \u2014 the negative prevention trial cited in the article.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Hong Kong Drug Office, Department of Health \u2014 verify local registration status of every systemic agent named.<\/span><\/li>\r\n<\/span><\/ol>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Eczema&nbsp; Atopic dermatitis: Clinical features&nbsp;The core features are itch (essential to the diagnosis \u2014 eczema without itch is not eczema), dryness, and an age-typical distribution with a chronic relapsing course.Supporting features frequently seen: extra folds under the lower eyelids (Dennie-Morgan lines), darkening around the eyes, pallor around the mouth, accentuated palm creases, keratosis pilaris (&#8220;chicken&hellip; <a class=\"more-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/clinical_features\/\">Continue reading <span class=\"screen-reader-text\">Clinical Features<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-619","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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