LCQ17: Provision of diagnoses and treatments for eczema patients
8.11.2023

Following is a question by the Hon Chan Hoi-yan and a written reply by the Acting Secretary for Health, Dr Libby Lee, in the Legislative Council today (November 8): Question: At present, the Hospital Authority does not offer specialist outpatient services on dermatology, and relevant services are provided by the nine dermatology clinics under the Department of Health (DH). However, it has been reported that the waiting time for such clinics is too long. Regarding the provision of diagnoses and treatments for eczema patients, will the Government inform this Council: (1) whether it knows the number of eczema patients seeking consultation at public hospitals because of eczema in each of the past five years; (2) whether it knows the respective numbers of patients with severe eczema who were referred to the dermatology clinics for follow-up through private healthcare institutions and public hospitals in each of the past five years; (3) whether it knows the longest, shortest and average waiting time of new cases at the dermatology clinics in each of the past five years (set out in a table); (4) whether it knows the total number of specialists in dermatology in the public healthcare system at present and, among them, the respective numbers of those working in DH and those who are residents at public hospitals; and (5) whether it will consider establishing a "dermatology specialist treatment centre" to centrally handle severe eczema cases, and setting up a fleet of "mobile clinics for dermatology specialist services" to provide nursing care for eczema patients with relatively mild conditions in the community, so as to divert eczema patients to different units for receiving services; if so, of the details; if not, the reasons for that? Reply: President, Eczema is a common group of skin diseases. The main symptoms are itch, redness, swelling or dryness and cracking of the skin. Most cases presented with mild symptoms, and are diagnosed and managed mainly by doctors in primary healthcare. Generally, the condition can be improved and controlled after being prescribed mild to moderate topical steroid ointments and strengthening skin care. For more serious or urgent cases, doctors would refer the patients to dermatology clinics under the Social Hygiene Service of the Department of Health (DH). In dermatology specialists' service, topical steroids or non-steroid ointments and oral anti-itch drugs of different strengths are prescribed according to the conditions of the patients, with strengthened skin care education, checking and avoiding of skin irritants or possible allergens that may be exposed in daily life, and follow-up on medication compliance. For some of the cases where the condition of the patient is not satisfactorily improved, the use of systemic oral drugs or light therapy would be further considered according to the therapeutic ladder. The reply, in consultation with the DH and the Hospital Authority (HA), to the question raised by the Hon Chan Hoi-yan is as follows: (1) The numbers of patients diagnosed with eczema in the General Out-patient Clinics (GOPCs) of the HA in the past five years are as follows: 2018-19 2019-20 2020-21 2021-22 2022-23 Number of eczema patients in GOPCs 82 093 77 054 81 843 74 768 56 028 Note: The Specialist Out-patient Clinics under the HA does not maintain statistics on eczema patients. (2) and (3) According to the data maintained by the DH, in 2022 (full year) and 2023 (as at September 30), there were 32 696 and 25 104 new cases respectively referred to the DH (including referrals from private medical institutions and public hospitals). Among them, 3 923 (12 per cent) and 3 665 (14.6 per cent) cases respectively were assessed and triaged as new cases with serious skin diseases. The DH does not maintain the statistics of patients with severe eczema referred to dermatology clinics from private medical institutions and public hospitals respectively. With effect from 2018, the Social Hygiene Service under the DH has adopted a triage system for new cases in dermatology specialty to ensure new cases with serious skin diseases will be cared with priority. This type of new cases will in general be arranged to be seen within eight weeks. The DH started to maintain the information of case waiting time systematically since the fourth quarter of 2021. In 2022 and 2023 (as at September 30), all new cases with serious skin diseases were arranged to be seen within eight weeks according to the performance pledge, with a median waiting time of 2.7 and 2.9 weeks respectively. As for other new cases with stable condition, the median waiting time was both 90 weeks, while the overall longest waiting time was 178 weeks and 183 weeks respectively. (4) and (5) Currently, there are 116 specialists in Dermatology and Venereology on the Specialist Register of the Medical Council of Hong Kong in Hong Kong where most are in private practice. There are 29 doctors serving in the Social Hygiene Service under the DH. Among them, nine are specialists in Dermatology and Venereology, while the remaining 20 doctors are members of the Hong Kong College of Physicians and have finished Basic Physician Training. For the HA, there are eight doctors providing dermatology services, among whom four are specialists in Dermatology and Venereology. In addition to consultation, specialists in the Social Hygiene Service under the DH also provide support and coaching to other doctors in the Social Hygiene Service to maintain and improve the service quality of local dermatology specialty and to train more local specialists in Dermatology. Eczema patients with relatively mild conditions are generally manageable by the primary healthcare doctors whom they are familiar with in a holistic approach and most cases do not require referral to dermatology clinics for follow-up. There are a total of nine clinics under the Social Hygiene Service of the DH that provide specialist dermatology service in different districts. These clinics can provide convenient and accessible service for cases with more serious or urgent cases which require referral to dermatology clinics. There is no current plan for the Government to set up treatment centre to treat serious eczema cases in a centralised way.