Eczema still uncontrolled by topical treatment: comparing phototherapy and dupilumab in Shanghai
If itching repeatedly wakes you up, or symptoms on your hands, face or other areas affect your work, first see a dermatologist and bring your topical medicines and photos taken during flare-ups. The doctor will check whether you have atopic dermatitis and review how you have used your medicines before discussing phototherapy, biologics or other systemic treatments. The number of follow-up visits needed and access to repeat prescriptions after you return home will also affect your choice.
Key points
- Bring the name of each topical medicine, where you apply it and how often you actually use it.
- Seek local medical care first if you develop sudden pain, widespread blistering or fever.
Show the doctor what your skin looks like at its worst
Label photos with the date and body area, and record how many nights you sleep poorly in a typical week and which activities are limited. Bring topical medicines in their original packaging and explain whether you have reduced their use because of stinging, work or cost. A dermatologist can distinguish atopic dermatitis, contact-related factors and possible infection, then decide whether patch testing or other tests are needed. The dermatology department at Shanghai Sixth People’s Hospital lists care for eczema, contact dermatitis and atopic dermatitis and can be a starting point for specialist consultation.
Comparing phototherapy and systemic treatments
Medical phototherapy involves supervised treatment sessions and often requires repeated hospital visits. Ask how many visits are needed each week, how treatment exposure is adjusted according to your skin’s response, whom to contact if you develop burning pain and whether treatment can continue close to home. Tanning beds cannot replace monitored medical phototherapy. Systemic treatments include injectable biologics, oral JAK inhibitors and traditional immunomodulatory medicines. The choice needs to take into account age, infection risk, other medical conditions, plans to conceive, testing requirements and how treatment is given in daily life.
How much does a box of dupilumab cost?
For dupilumab (达必妥, Dupixent) 300 mg/2 mL in a two-unit pack, the reference medicine cost in China is CNY 3,016. In the Netherlands, the reference charge for a two-unit pack of the same strength when the hospital has no contract with the patient’s insurer is EUR 1,175.00～1,257.74, depending on the specific packaging. Use the starting and maintenance doses specified by your doctor to calculate how many boxes you need each month, then add injection and follow-up visit costs.
Which changes guide whether to continue or adjust treatment?
Agree with your doctor on a date for the first reassessment, and review itching, sleep, skin lesions in important areas, the number of flare-ups and the amount of topical medicine used. Even if you switch to an injectable medicine, include moisturizers and topical medicines in your daily care plan. Contact your dermatologist if you develop new eye redness or dryness; eye pain, light sensitivity or changes in vision require a same-day visit to an eye emergency department or urgent eye clinic. Seek prompt local medical care if your skin suddenly becomes painful, or oozing or crusting spreads rapidly, especially with fever or widespread blisters. If further assessment is needed to clarify the diagnosis, see Shanghai assessment information for difficult-to-diagnose dermatitis and eczema.
Frequently asked questions
Do I still need moisturizers after starting injections?
Usually, you should continue using them. Ask your doctor to write separate, clear instructions for moisturizers, topical medicines for your face and different areas of your body, and what to do during a flare-up.
Is phototherapy suitable for a single short visit to Shanghai?
First ask about the expected frequency, treatment duration and where you can continue treatment locally. A single session is not enough to assess effectiveness.
What if my rash is milder than usual at the appointment?
Bring photos taken when it was worse and a sleep record, and explain how it affects bathing, studying or work. The doctor will consider more than how your skin looks that day.
I already have insurance. Which amount should I use for my budget?
First confirm your outpatient out-of-pocket costs, any limits and approval requirements with your insurer. Enter the amount you must personally pay, as confirmed in writing by your insurer, in the local budget column.
What if I cannot get the same pen after returning home?
Before your first dose, have the pharmacies in both locations check the brand, concentration, pen or syringe, and supply dates. Also ask your doctor to explain whom to contact if you cannot receive a dose on time.