{"id":880,"date":"2026-08-26T15:38:57","date_gmt":"2026-08-26T07:38:57","guid":{"rendered":"https:\/\/eczema.skinmedical.com.hk\/treatment-step4\/"},"modified":"2026-08-28T17:49:51","modified_gmt":"2026-08-28T09:49:51","slug":"treatment-step4","status":"publish","type":"page","link":"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step4\/","title":{"rendered":"Step 4: Conventional systemic treatment"},"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-aebd2999\" data-vce-do-apply=\"all el-aebd2999\"><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-5cf45f2f\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-5cf45f2f\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-5cf45f2f\"><div class=\"vce vce-separator-container vce-separator--align-center vce-separator--style-solid\" id=\"el-04ba6683\" data-vce-do-apply=\"margin el-04ba6683\"><div class=\"vce-separator vce-separator--color-bfc0c1 vce-separator--width-100 vce-separator--thickness-1\" data-vce-do-apply=\"border padding background  el-04ba6683\"><\/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-1000cd91\" data-vce-do-apply=\"all el-1000cd91\"><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-e1df49b8\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-e1df49b8\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-e1df49b8\"><div class=\"vce-single-image-container vce-single-image--align-center\"><div class=\"vce vce-single-image-wrapper\" id=\"el-426e876f\" data-vce-do-apply=\"all el-426e876f\"><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-a5d15929\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-a5d15929\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-a5d15929\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-c0df6aae\" data-vce-do-apply=\"all el-c0df6aae\"><h2><strong><span style=\"color: #756464;\"><span style=\"color: #756464;\">Evidence-based treatment<\/span><\/span><\/strong><\/h2>\r\n<p><span style=\"color: #756464;\"><span style=\"font-size: 15pt;\">The framework is a treatment ladder, and every level continues the one beneath it. Emollients never stop.<\/span><\/span><\/p>\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-10 vce-row-equal-height vce-row-content--top\" id=\"el-dbea163e\" data-vce-do-apply=\"all el-dbea163e\"><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-2a46d723\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-2a46d723\" vce-box-shadow=\"el-2a46d723\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-2a46d723\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-af89c032\" data-vce-do-apply=\"all el-af89c032\"><div style=\"text-align: center;\" align=\"center\">\r\n<table style=\"border-collapse: collapse; width: 93%; margin-right: calc(7%); border: medium none currentcolor;\">\r\n<tbody>\r\n<tr>\r\n<td style=\"color: #efefef; background-color: #efefef; border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><span style=\"color: #756464; font-size: 16px;\"><strong><span style=\"font-family: 'Google Sans', sans-serif;\">Step<\/span><\/strong><\/span><\/td>\r\n<td style=\"color: #efefef; background-color: #efefef; border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><strong><span style=\"font-family: 'Google Sans', sans-serif;\">Treatment<\/span><\/strong><\/span><\/td>\r\n<td style=\"color: #efefef; background-color: #efefef; border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px;\"><strong><span style=\"font-family: 'Google Sans', sans-serif;\">Indication<\/span><\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/evidence-based-treatment\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Foundation<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Emollients, bathing practice, trigger avoidance<\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Everyone, always<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step1\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Step 1<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Topical corticosteroids; topical calcineurin inhibitors<\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Mild-to-moderate; flare treatment<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step2\/\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Step 2<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Proactive maintenance twice weekly; non-steroidal topicals (PDE4 inhibitors, topical JAK, tapinarof)<\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Recurrent flares at the same sites<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step3\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Step 3<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\"><strong>Narrowband UVB phototherapy<\/strong><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Moderate disease inadequately controlled by topicals; useful steroid-sparing option<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step4\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Step 4<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Conventional systemics: ciclosporin, methotrexate, azathioprine, mycophenolate<\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Moderate-to-severe<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 17.3819%;\"><a href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step5\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\"><strong>Step 5<\/strong><\/span><\/span><\/a><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 40.867%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Biologics; oral JAK inhibitors<\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; text-align: center; width: 41.7646%;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Moderate-to-severe inadequately controlled by the above<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\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-10 vce-row-equal-height vce-row-content--top\" id=\"el-056585b8\" data-vce-do-apply=\"all el-056585b8\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-10p 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-a7f05af0\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-a7f05af0\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-a7f05af0\"><div class=\"vce-single-image-container vce-single-image--align-center\"><div class=\"vce vce-single-image-wrapper\" id=\"el-c76f0ab1\" data-vce-do-apply=\"all el-c76f0ab1\"><figure><div class=\"vce-single-image-figure-inner\" style=\"width: 100px;\"><div class=\"vce-single-image-inner vce-single-image--absolute\" style=\"width: 100%; padding-bottom: 100%;\"><img decoding=\"async\" class=\"vce-single-image\" src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/eczema_icon_step4.png\" data-img-src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/eczema_icon_step4.png\" data-attachment-id=\"752\" alt=\"\u6fd5\u75b9 \u53e3\u670d \u6cbb\u7642 \u9999\u6e2f\" title=\"eczema_icon_step4\"><\/div><\/div><figcaption hidden=\"\"><\/figcaption><\/figure><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-90p 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-14817c9f\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-14817c9f\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-14817c9f\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-db3321ab\" data-vce-do-apply=\"all el-db3321ab\"><h2><span style=\"color: #756464;\">Step 4: Conventional systemic treatment<\/span><\/h2>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-6ffc14e9\" data-vce-do-apply=\"all el-6ffc14e9\"><p><span style=\"color: #756464;\">For moderate-to-severe disease when the above is insufficient. All require baseline and ongoing blood monitoring.<\/span><\/p>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-608269d2\" data-vce-do-apply=\"all el-608269d2\">\r\n<ul>\r\n \t<span style=\"color: #756464;\">\r\n<li><span style=\"color: #756464;\"><strong>Ciclosporin<\/strong> \u2014 fastest acting, with meaningful improvement often within 2\u20136 weeks. Used for short courses (typically up to 6\u201312 months) because of blood pressure and kidney effects. Excellent for rescuing a severe flare.<\/span><\/li>\r\n<li><strong>Methotrexate<\/strong> \u2014 slower, better for long-term use, once weekly, generally well tolerated.<\/li>\r\n<li><strong>Azathioprine<\/strong> \u2014 requires TPMT testing before starting.<\/li>\r\n<li><strong>Mycophenolate mofetil<\/strong> \u2014 an alternative where the above are unsuitable.<\/li>\r\n<\/span><\/ul>\r\n<p>&nbsp;<\/p>\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-10 vce-row-equal-height vce-row-content--top\" vce-box-shadow=\"el-bf77302b\" id=\"el-bf77302b\" data-vce-do-apply=\"all el-bf77302b\"><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-ac76d3ce\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-ac76d3ce\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-ac76d3ce\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-78c57001\" data-vce-do-apply=\"all el-78c57001\"><p style=\"text-align: center;\"><span style=\"color: #756464;\"><strong>Oral corticosteroids<\/strong> deserve a specific warning. <\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #756464;\">They work rapidly and are therefore tempting, but eczema characteristically rebounds worse than before when they stop. They have a role only as a short bridge in a severe flare, never as ongoing treatment. Repeated courses of oral steroids for eczema is a pattern worth reviewing.<\/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-53287f22\" data-vce-do-apply=\"all el-53287f22\"><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-57b4e6c7\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-57b4e6c7\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-57b4e6c7\"><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-content--top\" id=\"el-e6d1c931\" data-vce-do-apply=\"all el-e6d1c931\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-20p 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-e2d4a3c4\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-e2d4a3c4\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-e2d4a3c4\"><div class=\"vce-features vce-var-icon vce-features--style-filled-circle vce-features--size-small\" style=\"--iconAlignment: center; --iconColor: rgb(255, 255, 255); --iconColorHover: #fff; --shapeColor: rgb(175, 163, 150); --shapeColorHover: rgb(218, 218, 218); --linkColorHover: rgb(157,146,134);\"><div id=\"el-f1f9aa39\" class=\"vce vce-features-icon-wrapper\" data-vce-do-apply=\"all el-f1f9aa39\"><a class=\"vce-features--icon vce-icon\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step1\/\" title=\"\u7b2c\u4e00\u7d1a: \u5916\u7528\u6297\u708e\u6cbb\u7642\" target=\"_blank\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 769 769\"><path stroke-width=\"25\" d=\"M565.755 696.27h-360l-180-311.77 180-311.77h360l180 311.77z\"><\/path><\/svg><span class=\"vce-icon-container vcv-ui-icon-dripicons vcv-ui-icon-dripicons-brush\"><\/span><\/a><\/div><\/div><div class=\"vce-google-fonts-heading vce-google-fonts-heading--align-center vce-google-fonts-heading--color-b-62-61-61--45--5C00FF--FF7200 vce-google-fonts-heading--font-family-Sanchez\"><div id=\"el-fe974a02\" class=\"vce-google-fonts-heading-wrapper\"><div class=\"vce-google-fonts-heading--background vce\" data-vce-do-apply=\"border background  padding margin el-fe974a02\"><h2 class=\"vce-google-fonts-heading-inner\" style=\"font-size: 20px; letter-spacing: 2px; font-weight: 400; font-style: normal;\"><a class=\"vce-google-fonts-heading-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step1\/\" title=\"Step 1: Topical anti-inflammatory treatment\" target=\"_blank\">Step 1: Topical anti-inflammatory treatment<\/a><\/h2><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-20p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first\" id=\"el-f7da1ef6\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-f7da1ef6\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-f7da1ef6\"><div class=\"vce-features vce-var-icon vce-features--style-filled-circle vce-features--size-small\" style=\"--iconAlignment: center; --iconColor: rgb(255, 255, 255); --iconColorHover: #fff; --shapeColor: rgb(175, 163, 150); --shapeColorHover: rgb(218, 218, 218); --linkColorHover: rgb(157,146,134);\"><div id=\"el-5286f06f\" class=\"vce vce-features-icon-wrapper\" data-vce-do-apply=\"all el-5286f06f\"><a class=\"vce-features--icon vce-icon\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step2\/\" title=\"\u7b2c\u4e8c\u7d1a: \u4e3b\u52d5\u7dad\u6301\u6cbb\u7642\" target=\"_blank\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 769 769\"><path stroke-width=\"25\" d=\"M565.755 696.27h-360l-180-311.77 180-311.77h360l180 311.77z\"><\/path><\/svg><span class=\"vce-icon-container vcv-ui-icon-batch vcv-ui-icon-batch-plus\"><\/span><\/a><\/div><\/div><div class=\"vce-google-fonts-heading vce-google-fonts-heading--align-center vce-google-fonts-heading--color-b-62-61-61--45--5C00FF--FF7200 vce-google-fonts-heading--font-family-Sanchez\"><div id=\"el-56695365\" class=\"vce-google-fonts-heading-wrapper\"><div class=\"vce-google-fonts-heading--background vce\" data-vce-do-apply=\"border background  padding margin el-56695365\"><h2 class=\"vce-google-fonts-heading-inner\" style=\"font-size: 20px; letter-spacing: 2px; font-weight: 400; font-style: normal;\"><a class=\"vce-google-fonts-heading-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step2\/\" title=\"Step 2: Proactive maintenance \" target=\"_blank\">Step 2: Proactive maintenance <\/a><\/h2><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-20p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first\" id=\"el-a9426a65\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-a9426a65\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-a9426a65\"><div class=\"vce-features vce-var-icon vce-features--style-filled-circle vce-features--size-small\" style=\"--iconAlignment: center; --iconColor: rgb(255, 255, 255); --iconColorHover: #fff; --shapeColor: rgb(175, 163, 150); --shapeColorHover: rgb(237, 237, 237); --linkColorHover: rgb(157,146,134);\"><div id=\"el-3ec26523\" class=\"vce vce-features-icon-wrapper\" data-vce-do-apply=\"all el-3ec26523\"><a class=\"vce-features--icon vce-icon\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step3\/\" title=\"\u7b2c\u4e09\u7d1a: \u7a84\u983b NB-UVB \u5149\u7642\" target=\"_blank\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 769 769\"><path stroke-width=\"25\" d=\"M565.755 696.27h-360l-180-311.77 180-311.77h360l180 311.77z\"><\/path><\/svg><span class=\"vce-icon-container vcv-ui-icon-dripicons vcv-ui-icon-dripicons-vibrate\"><\/span><\/a><\/div><\/div><div class=\"vce-google-fonts-heading vce-google-fonts-heading--align-center vce-google-fonts-heading--color-b-62-61-61--45--5C00FF--FF7200 vce-google-fonts-heading--font-family-Sanchez\"><div id=\"el-17a0f6cf\" class=\"vce-google-fonts-heading-wrapper\"><div class=\"vce-google-fonts-heading--background vce\" data-vce-do-apply=\"border background  padding margin el-17a0f6cf\"><h2 class=\"vce-google-fonts-heading-inner\" style=\"font-size: 20px; letter-spacing: 2px; font-weight: 400; font-style: normal;\"><a class=\"vce-google-fonts-heading-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step3\/\" title=\"Step 3: NB-UVB Phototherapy\" target=\"_blank\">Step 3: NB-UVB Phototherapy<\/a><\/h2><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-20p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first\" id=\"el-97fd84e6\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-97fd84e6\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-97fd84e6\"><div class=\"vce-features vce-var-icon vce-features--style-filled-circle vce-features--size-small\" style=\"--iconAlignment: center; --iconColor: rgb(255, 255, 255); --iconColorHover: #fff; --shapeColor: rgb(175, 163, 150); --shapeColorHover: rgb(237, 237, 237); --linkColorHover: rgb(157,146,134);\"><div id=\"el-97b3f1bf\" class=\"vce vce-features-icon-wrapper\" data-vce-do-apply=\"all el-97b3f1bf\"><a class=\"vce-features--icon vce-icon\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step4\/\" title=\"\u7b2c\u56db\u7d1a: \u50b3\u7d71\u7cfb\u7d71\u6027\u6cbb\u7642\" target=\"_blank\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 769 769\"><path stroke-width=\"25\" d=\"M565.755 696.27h-360l-180-311.77 180-311.77h360l180 311.77z\"><\/path><\/svg><span class=\"vce-icon-container vcv-ui-icon-mfglabs vcv-ui-icon-mfglabs-link\"><\/span><\/a><\/div><\/div><div class=\"vce-google-fonts-heading vce-google-fonts-heading--align-center vce-google-fonts-heading--color-b-62-61-61--45--5C00FF--FF7200 vce-google-fonts-heading--font-family-Sanchez\"><div id=\"el-2eeb8ab1\" class=\"vce-google-fonts-heading-wrapper\"><div class=\"vce-google-fonts-heading--background vce\" data-vce-do-apply=\"border background  padding margin el-2eeb8ab1\"><h2 class=\"vce-google-fonts-heading-inner\" style=\"font-size: 20px; letter-spacing: 2px; font-weight: 400; font-style: normal;\"><a class=\"vce-google-fonts-heading-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step4\/\" title=\"Step 4: Conventional systemic treatment\" target=\"_blank\">Step 4: Conventional systemic treatment<\/a><\/h2><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-20p 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-51fb430d\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-51fb430d\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-51fb430d\"><div class=\"vce-features vce-var-icon vce-features--style-filled-circle vce-features--size-small\" style=\"--iconAlignment: center; --iconColor: rgb(255, 255, 255); --iconColorHover: #fff; --shapeColor: rgb(175, 163, 150); --shapeColorHover: rgb(237, 237, 237); --linkColorHover: rgb(157,146,134);\"><div id=\"el-d6ac8525\" class=\"vce vce-features-icon-wrapper\" data-vce-do-apply=\"all el-d6ac8525\"><a class=\"vce-features--icon vce-icon\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step5\/\" title=\"\u7b2c\u4e94\u7d1a: \u751f\u7269\u88fd\u5291\u8207\u53e3\u670d JAK \u6291\u5236\u5291\" target=\"_blank\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 769 769\"><path stroke-width=\"25\" d=\"M565.755 696.27h-360l-180-311.77 180-311.77h360l180 311.77z\"><\/path><\/svg><span class=\"vce-icon-container vcv-ui-icon-dripicons vcv-ui-icon-dripicons-pulse\"><\/span><\/a><\/div><\/div><div class=\"vce-google-fonts-heading vce-google-fonts-heading--align-center vce-google-fonts-heading--color-b-62-61-61--45--5C00FF--FF7200 vce-google-fonts-heading--font-family-Sanchez\"><div id=\"el-a59510c6\" class=\"vce-google-fonts-heading-wrapper\"><div class=\"vce-google-fonts-heading--background vce\" data-vce-do-apply=\"border background  padding margin el-a59510c6\"><h2 class=\"vce-google-fonts-heading-inner\" style=\"font-size: 20px; letter-spacing: 2px; font-weight: 400; font-style: normal;\"><a class=\"vce-google-fonts-heading-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step5\/\" title=\"Step 5: Biologics and oral JAK inhibitors\" target=\"_blank\">Step 5: Biologics and oral JAK inhibitors<\/a><\/h2><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/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-60a1350d\" data-vce-do-apply=\"all el-60a1350d\"><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-4352c4c3\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-4352c4c3\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-4352c4c3\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-d0dbfb02\" data-vce-do-apply=\"all el-d0dbfb02\"><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>Evidence-based treatment The framework is a treatment ladder, and every level continues the one beneath it. Emollients never stop. Step Treatment Indication Foundation Emollients, bathing practice, trigger avoidance Everyone, always Step 1 Topical corticosteroids; topical calcineurin inhibitors Mild-to-moderate; flare treatment Step 2 Proactive maintenance twice weekly; non-steroidal topicals (PDE4 inhibitors, topical JAK, tapinarof) Recurrent flares&hellip; <a class=\"more-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/treatment-step4\/\">Continue reading <span class=\"screen-reader-text\">Step 4: Conventional systemic treatment<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":760,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-880","page","type-page","status-publish","has-post-thumbnail","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Step 4: Conventional systemic treatment<\/title>\n<meta name=\"description\" content=\"For moderate-to-severe disease when the above is insufficient. 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