Background: Non-adherence is a major hindrance to treatment success in any disease. In chronic diseases, adherence to long term treatment is about 50% but existing data on adherence to topical treatment in dermatological diseases are limited. In atopic eczema (AE), adherence to topical therapy is essential to control inflammation and maintain adequate moisturization but these treatment aims will not be achieved without optimal adherence. Objectives: To assess the frequency of treatment adherence among our patients with AE and to identify the influencing factors. Methods: We carried out a questionnaire-based study involving dermatology outpatients with AE. Demographic data were collected and patients or carers were interviewed to assess steroid phobia, knowledge, perception on treatment and use of alternative treatment. Results: Out of 75 patients included in the study, only 14.7% were adherent to treatment. 58.7% of patients had steroid phobia but this did not significantly affect adherence. 41% of patients who use alternative treatment had poor adherence compared to patients who did not. Conclusion: Adherence to topical treatment is poor among our AE patients and multi-pronged intervention is needed to improve adherence. For clinicians, non-adherence should be considered when managing patients who appear ‘resistant’ to optimized treatment.