Atopic Dermatitis in Asia - the Plan, Problems and Path Forward
- Bridges M&C team
- Jan 12
- 6 min read
Updated: 3 days ago
Why better systems, education and access matter as much as new drugs in atopic dermatitis care.
Clinically it ranges from mild, localized dry patches to severe, widespread inflamed skin with secondary infection and thickened, lichenified areas. The course of disease is unpredictable: periods of remission alternate with flares triggered by infections, allergens, weather, or gaps in treatment adherence.
Beyond skin symptoms, atopic dermatitis commonly impairs sleep, school and work performance, and mental health. The condition frequently coexists with other atopic conditions such as asthma and allergic rhinitis, increasing cumulative life-course burden.
Prevalence in Asia
Across Asia rates vary, but the burden is substantial.
In Japan, prevalence of atopic dermatitis in children is among the highest in Asia, with studies reporting rates of around 11% to 17% in children. Although a slight decline has een reported over time, levels remain high. In adults, prevalence of the disease is also relatively high, partly due to adult-onset disease.
In Hong Kong, children have higher rates of atopic dermatitis than adults. Early studies in the 2000s showed relatively low prevalence, around 4% among children aged six to 14 years. However more recent data shows a significant increase; a 2022 survey of secondary school students reported that over one quarter had eczema, indicating that atopic dermatitis has become much more common in recent years.
Studies show prevalence in Malaysia has risen over time. Data from the International Study of Asthma and Allergies in Childhood (ISAAC) indicated a 12-month prevalence rising from about 9.5% from 1994 to 1995, to 12.6% in the early 2000s, and later local studies report childhood prevalence figures in the low teens; at ~13.4% in some cohorts, for example. National guidance in Malaysia acknowledges this rise and the considerable direct and indirect costs of atopic dermatitis.
Singapore has similarly high rates among children; multiple local studies and institutional analyses estimate approximately 20% of children and 10% to11% of adults are affected, with local clinicians reporting a rising share of moderate-to-severe cases requiring specialist care. Recent national research initiatives aim to fill remaining gaps in knowledge about prevalence, severity and drivers in Asian populations.
Why is treatment for atopic dermatitis so challenging?
Atopic dermatitis looks straightforward on paper, as the treatment includes to moisturize, treat inflammation, avoid triggers, but in practice, treatment is complex for several reasons. Several challenges were identified at the recent 15th Georg RAJKA International Symposium on Atopic Dermatitis (ISAD), where clinicians and patient advocates from multiple regions emphasised adherence, steroid education, culturally adapted counselling and the need for shared decision-making as recurring priorities.
First and foremost, adherence to treatment for atopic dermatitis is poor. Professor Ellis Hon of the Chinese University of Hong Kong said, "Many patients stop emollients and topical treatments when skin improves, or they never learn correct application routines." Dr Masaki Futamura, Chief Doctor at the National Hospital Organization Nagoya Medical Centre, Japan stressed, "Steroid phobia is common, as patients fear topical corticosteroids and may underuse them, worsening outcomes."
The second factor to consider is the financial and access barriers for patients. Advanced systemic agents such as biologics and Janus kinase (JAK) inhibitors are transformational for moderate-to-severe AD, but cost and reimbursement constraints limit access across many countries. Even where these medicines are available, monitoring and specialist follow-up requirements can be burdensome.
Misinformation and cultural beliefs also play a role in the treatment and management of AD. Dr Leong Kin Fon, a paediatric dermatologist attached to Hospital Kuala Lumpur in Malaysia emphasises that myths about triggers, remedies and the nature of remission complicate consultations as patients frequently present with preconceptions that must be unlearned before evidence-based plans can be accepted. Furthermore, clinical heterogeneity and skin type differences must also be taken into consideration. Symptoms such as redness may be less obvious in darker skin tones, complicating assessment of disease activity. Atopic dermatitis phenotypes and co-morbidities tend to vary, requiring tailored treatment approaches.
Additionally, workforce constraints can further complicate the treatment of the disease. The time demands of high-quality counselling and longer initial consultations conflict with the operational pressures of busy clinics, constraining clinicians’ capacity to establish rapport and deliver patient education, both of which are essential for sustained disease control.
What works today: practical solutions that help now
The good news is that many effective, scalable interventions exist. Speaking at the ISAD symposium, Dr Leong, Dr Futamura and Professor Hon, along with Amanda Creswell-Melville, Executive Director or the Eczema Society of Canada, identified the four broad categories of interventions, which include education, pragmatic care pathways, accessible therapeutics, and system-level collaboration.
To find solutions of atopic dermatitis sufferers, patient and caregiver education are of utmost importance. Dr Leong elaborates. “Education needs to be simple, actionable and repeated, as well as culturally adaptable, and clinicians should teach patients to assess disease by feel, such as degree of itch, as well as how it appears, for example extent of scaliness and lichenification, demonstrate emollient application, and explain the role, safety and correct use of topical corticosteroids to dispel steroid phobia,”
Patient communities and peer education groups improve uptake, where a trained patient can become the most effective educator in many settings. Dr Leong further mentions that clinicians should aim to develop materials collaboratively with local patient groups in order to ensure clarity and cultural fit.
Practical treatment plans and shared decision timing can also serve as practical solutions in the current treatment landscape. Many clinicians at the ISAD Symposium stressed on the use of a clear, memorable framework, where simple ABC routines, i.e.: Avoid triggers → Barrier repair → Corticosteroids/Calcineurin inhibitors) can work, followed by building Plan A/B/C strategies so patients know when to step up or step down therapy. Critically, shared clinician-patient decision-making should also be timed. For example, during an acute flare, clinicians must use the firefighter approach and act decisively, then engage the patient in shared choices when the flare is controlled.
Better use of existing treatment modalities and creative combinations of medications/ therapy is another category of practical solutions that can be employed. When access to biologics or JAK inhibitors is limited by cost, creative 'mix-and-match' regimens which include spacing biologic doses and combining with phototherapy or systemic immunosuppressants where safe, can stretch resources while maintaining control. Professor Hon reported success using interval therapy to induce remission, then consolidating gains with conventional treatments.
By making advanced therapies work for more people, rapid and sustained improvements in signs, symptoms and quality of life in trials and real-world studies for patients can be achieved. Biologics, notably dupilumab, and newer agents have transformed outcomes for many patients with moderate-to-severe AD. Evidence supports significant gains in itch reduction, with acceptable safety profiles in long-term follow up. Where cost or prescribing restrictions exist, targeted use for the most severe, refractory patients yields high value.
Dr Leong, Professor Hon and Dr Futamura agree that addressing AD at population level requires policy action: include eczema in public health priorities, expand reimbursement pathways for high-value therapies, fund training for primary care so more patients receive correct initial care, and invest in public education campaigns to dispel myths. Data sharing between countries, and shared educational resources co-developed with patient groups, reduce duplication and raise the baseline of care, says Amanda Creswell-Melville.
The way forward: where the treatment landscape is heading
The next five to 10 years will likely bring three converging trends that could reshape care:
Wider adoption of targeted systemic therapies. As biosimilars, new biologics and oral targeted agents such as JAK inhibitors mature, cost and accessibility will improve. Evidence supports substantial quality-of-life gains for patients with severe disease; national formularies and reimbursement dialogues should prioritise high-impact use cases.
Better stratification and personalised care. Biomarker research, improved phenotyping, and integrated clinical pathways will allow clinicians to predict who needs escalated therapy and who can be managed with topical care and education. This means fewer patients are overtreated and more patients with severe disease receive timely advanced care.
Digital and community-based solutions to scale education and support. Telemedicine, patient apps, moderated online communities and co-created educational content can help extend specialist knowledge into primary care and patient homes. The roundtable’s emphasis on patient-led resources and global sharing points to pragmatic, low-cost ways to expand reach.
Conclusion
Atopic dermatitis is a common, often hidden burden that affects not just skin but sleep, mental health, family life and productivity. The clinical toolbox has expanded dramatically: better topical regimens, evidence-based education approaches, phototherapy, and disease-modifying biologics and small molecules. Yet the benefits of scientific progress will remain uneven unless systems prioritise patient education, timing of shared decision-making, equitable access to advanced therapies and international collaboration to share resources.
The ISAD symposium in Melbourne reminds us that real change does not come from drugs alone; it comes from listening to patients, simplifying clinical guidance, training patients and clinicians, and crafting policies that make life-changing therapies accessible to those who need them most.
With coordinated action, which include combining practical education, strategic use of new medicines, and system-level reforms, the next decade can be one in which atopic dermatitis moves from chronic burden to manageable long-term condition for millions across Southeast Asia and the wider region.
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