Adherence to topical dermatological therapy: lessons from oral drug treatment

Abstract

Patients are remarkably nonadherent to medical treatment regimens across all diseases and classes of therapy, and it has been estimated that nonadherence to drug treatment is responsible for as many as 10% of all hospital admissions. Nonadherence to treatment also has significant negative effects on treatment outcomes across a wide range of diseases. Patient-related factors such as age, ethnicity, literacy (including health literacy), health beliefs, and socioeconomic conditions have been shown to influence adherence to oral therapy. Medication-related factors, such as regimen complexity and duration of treatment, also impact on adherence. Variables that significantly influence adherence to oral drugs have similar effects on adherence to topical therapy. Both educational and psychological interventions along with simplification of dosing regimens can significantly improve adherence to oral therapy and limited evidence indicates that these approaches are also effective in patients receiving topical therapy. There is very little information about the effects of dosing regimens on adherence to topical medical therapy. The advent of new drug formulations that permit once-daily or single-dose drug application will, however, permit evaluation of different topical treatment regimens on adherence and treatment outcomes in patients with dermatological disease.

A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease – strategies for optimizing treatment outcome

“…A very important and often underestimated patient‐related factor is mental health. In fact, psychiatric disorders like depression and anxiety have been demonstrated to be significant risk factors for non‐adherence . This finding is highly relevant, as the prevalence of psychiatric illnesses among dermatological patients ranges from 25% to 43% …”

Current issues in the management of actinic keratosis

“…53,76 Educational and psychosocial interventions, together with a well-functioning doctor-patient relationship, foster adherence. 53,76 Patients value cost consciousness and clear instruction both in verbal and written form.…”

Patient‐reported outcomes from two randomised studies comparing once‐weekly application of amorolfine 5% nail lacquer to other methods of topical treatment in distal and lateral subungual onychomycosis

“…Patient adherence to long‐term topical treatment may depend not only on the efficacy of the treatment but also on the ease of use, application procedure and tolerance. Such factors include inconvenient or time‐consuming application of medication, ambiguous/complicated usage instructions or side effects such as irritation, burning and dryness . These subjective factors are infrequently assessed in prospective randomised studies.…”