How to Increase Adherence and Compliance in Acne Treatment? A Combined Strategy of SMS and Visual Instruction Leaflet

Abstract

Introduction: Acne is a common skin disease with important psychosocial impact. Often inadequate compliance affects the efficacy of the therapy. Because of emerging use of mobile and electronic health technology, the recent literature evaluated the helpfulness of the tools in medication adherence. The first goal of our study was to evaluate the adherence to therapy with topical adapalene 0.3%/benzoyl peroxide (A-BPO) 2.5% in different groups of patients who received explicative information supported by different strategies. The second goal was to evaluate the patient’s quality of life and skin parameters. Materials and Methods: We enrolled 126 subjects with mild to severe acne vulgaris. They were randomized into 3 groups of 42 patients each and applied daily topical A-BPO (0.3%, 2.5%) for 12 weeks. The first group (G1) was trained on the gel application by an explicative leaflet. The second group (G2) received the same instructions as group 1 and a daily SMS to remind them of the application of the product. The third group (G3) only received standard instructions. Evaluations were performed at the beginning of treatment (T0) and after 12 weeks (T1): assessment of acne severity using the Investigator’s Global Assessment (IGA) Scale for Acne Severity, quality of life by the Cardiff Acne Disability Index (CADI) and the Patient-Doctor Relationship Depth-of-Relationship Scale (PDRDS), skin pH, grade of hydration and adherence to treatment with a 7-day recall calendar were also measured. Results: After 12 weeks of therapy, we observed a reduction in IGA in all groups confirming the clinical efficacy of the product. In the multiple comparison analysis of IGA score reduction, a significant difference was found in G2 versus G1 and G2 versus G3, while the G1 versus G3 comparison was not statistically significant. However, the leaflet group (G1) showed better results compared to the no-leaflet group (G3). Supporting these data, we observed that adherence days correlated positively with the improvement of the single parameters. Moreover, we observed that SMS and leaflet groups had a greater improvement in quality of life evaluated by CADI and PDRDS scores. Conclusions: According to our data, this experimental setup based on text message service and leaflet service is inexpensive and easy to use. Physicians could consider using these items in their practice to enhance patient adherence and satisfaction as well as treatment outcome.

The effect of the “stay‐at‐home” policy on requests for dermatology outpatient clinic visits after the COVID ‐19 outbreak

“…This may be due to the fact that acne is more common in adolescents, who are risk‐taking individuals, and the fact that using isotretinoin requires continuity. Acne can have a significant psychosocial impact on patients, which leads to high rates of treatment compliance among acne patients; thus, these patients are likely to maintain their scheduled follow‐up visits 12 . Additionally, it is well known that fatality rates in young adults with COVID‐19 are low, hence continuing the adolescent patient referral stream by other physicians to the dermatology outpatient clinics 13 .…”

“…Acne can have a significant psychosocial impact on patients, which leads to high rates of treatment compliance among acne patients; thus, these patients are likely to maintain their scheduled follow-up visits. 12 Additionally, it is well known that fatality rates in young adults with COVID-19 are low, hence continuing the adolescent patient referral stream by other physicians to the dermatology outpatient clinics. 13 One additional important point which should be addressed is the increasing number of acne…”

Medication adherence and its possible associated factors in patients with acne vulgaris: A cross‐sectional study of 200 patients in Iran

“…Forgetting to take medications is another common reason for poor adherence in acne patients 19,29,30 . Use of technology such as text messaging (SMS) has been reported to be associated with improved adherence to medication, better clinical outcomes, increased appointment attendance, decreased amount of missed medication doses, more positive attitudes toward medication, and reductions in treatment interruptions 37,38 . A recent study demonstrated that web‐based educational tools on a weekly basis had a positive effect on treatment adherence in acne patients; although, telephone‐based reminders on a daily basis did not improve medication adherence in acne treatment 6 .…”

A Double-Blinded, Randomized, Vehicle-Controlled Study of the Efficacy of Moisturizer Containing Licochalcone A, Decanediol, L-Carnitine, and Salicylic Acid for Prevention of Acne Relapse in Asian Population

“…Among topical retinoids, adapalene was reported to cause less skin irritation [ 7 , 8 ]. As such, the side effects of topical retinoids may lead to a poor patient compliance and unsuccessful treatment [ 9 ].…”