Skip to main content
SpringerLink
Log in

Pharmionics in Dermatology

A Review of Topical Medication Adherence

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

The objective of this article was to review patient adherence to topical medications and its relationship to health outcomes in dermatologic disease. To this end, MEDLINE searches from January 1966 through June 2006 and EMBASE searches from January 1974 through June 2006 were conducted. Relevant human efficacy studies, including randomized controlled trials, observational studies, and case-control studies, were selected on the basis of the key words ‘compliance,’ ‘adherence,’ ‘pharmionics,’ ‘topical,’ ‘medication,’ or ‘dermatology.’ Studies were included and reviewed on the basis of their experimental design, controls, and statistical analysis. Analysis revealed that suboptimal adherence to topical medications is a common cause of minimal response or lack of response to drugs and is linked with poor dermatologic outcomes in diseases such as psoriasis, atopic dermatitis, and acne. It is concluded that non-adherence to topical medications is as common as non-adherence to oral medications, and its relationship to poor health outcomes is clear. Several barriers to topical medication adherence and predictors of non-adherence are similar to those for oral medications, while other barriers and predictors are unique to topical medications and the nature of dermatologic disease. Further studies of effective interventions to increase adherence are necessary to improve health outcomes in dermatology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. Gerbino PP. Patient compliance. Ann Pharmacother. 1993; 27: S3–16

    Google Scholar 

  2. Vrijens B, Urquhart J. Patient adherence to prescribed antimicrobial drug dosing regimens. J Antimicrob Chemother. 2005; 55 (5): 616–27

    Article  PubMed  CAS  Google Scholar 

  3. McKenney JM, Munroe WP, Wright JT. Impact of an electronic medication compliance aid in long-term blood pressure control. J Clin Pharmacol. 1992; 32: 277–83

    PubMed  CAS  Google Scholar 

  4. Cheng CWR, Woo KS, Chan JCN, et al. Assessing adherence to statin therapy using patient report, pill count, and an electronic monitoring advice. Am J Health Syst Pharm. 2005; 62: 411–5

    PubMed  Google Scholar 

  5. Kogut SJ, Andrade SE, Willey C, et al. Nonadherence as a predictor of antidiabetic drug therapy intensification (augmentation). Pharmacoepidemiol Drug Saf. 2004; 13: 591–8

    Article  PubMed  Google Scholar 

  6. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000; 133: 21–30

    PubMed  CAS  Google Scholar 

  7. Cramer J, Vachon L, Desforges C, et al. Dose frequency and dose interval compliance with multiple antiepileptic medications during a controlled clinical trial. Epilepsia. 1995; 36 (11): 1111–7

    Article  PubMed  CAS  Google Scholar 

  8. Cramer JA, Mattson RH, Prevey ML, et al. How often is medication taken as prescribed?. JAMA. 1989; 261 (22): 3273–7

    Article  PubMed  CAS  Google Scholar 

  9. Cramer JA. Microelectronic systems for monitoring and enhancing patient compliance with medication regimens. Drugs. 1995; 49 (3): 321–6

    Article  PubMed  CAS  Google Scholar 

  10. Balkrishnan R, Carroll CL, Camacho FT, et al. Electronic monitoring of medication adherence in skin disease: results of a pilot study. J Am Acad Dermatol. 2003; 49 (4): 651–4

    Article  PubMed  Google Scholar 

  11. Carroll CL, Feldman SR, Camacho FT, et al. Adherence to topical therapy decreases during the course of an 8-week psoriasis clinical trial: commonly used methods of measuring adherence to topical therapy overestimate actual use. J Am Acad Dermatol. 2004; 51 (2): 212–6

    Article  PubMed  Google Scholar 

  12. Balkrishnan R. Predictors of medication adherence in the elderly. Clin Ther. 1998; 20 (4): 764–71

    Article  PubMed  CAS  Google Scholar 

  13. Cramer JA. Relationship between medication compliance and medical outcomes. Am J Health Syst Pharm. 1995; 52 (S3): S27–9

    PubMed  CAS  Google Scholar 

  14. Urquhart J. Pharmacoeconomic consequences of variable patient compliance with prescribed drug regimens. Pharmacoeconomics. 1999; 15 (3): 217–28

    Article  PubMed  CAS  Google Scholar 

  15. Sleath B, Roter D, Chewning B, et al. Asking questions about medication: analysis of physician-patient interactions and physician perceptions. Med Care. 1999; 37 (11): 1169–73

    Article  PubMed  CAS  Google Scholar 

  16. Witkowski JA. Compliance: the dermatologic patient. Int J Dermatol. 1998; 27 (9): 608–11

    Article  Google Scholar 

  17. Zaghoul SS, Goodfield MJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004; 140: 408–14

    Article  Google Scholar 

  18. Richards HL, Fortune DG, O’Sullivan TM, et al. Patients with psoriasis and their compliance with medication. J Am Acad Dermatol. 1999; 41 (4): 581–3

    PubMed  CAS  Google Scholar 

  19. Carroll CL, Feldman SR, Camacho FT, et al. Better medication adherence results in greater improvement in severity of psoriasis. Br J Dermatol. 2004; 151: 895–7

    Article  PubMed  CAS  Google Scholar 

  20. Osbome JE, Hutchinson PE. The importance of accurate dosage of topical agents: a method of estimating involved area and application to calcipotriol treatment failures. J Fur Acad Dermatol Venereol. 2002; 16: 367–73

    Article  Google Scholar 

  21. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol. 2000; 142: 931–6

    Article  PubMed  CAS  Google Scholar 

  22. Cork MJ, Britton J, Butler L, et al. Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol. 2003; 149: 582–9

    Article  PubMed  CAS  Google Scholar 

  23. Zaghoul SS, Cunliffe WJ, Goodfield MJD. Objective assessment of compliance with treatments in acne. Br J Dermatol. 2005; 152: 1015–21

    Article  Google Scholar 

  24. Boggild AK, From L. Barriers to sun safety in a Canadian outpatient population. J Cutan Med Surg. 2003; 7 (4): 292–9

    Article  PubMed  Google Scholar 

  25. Geller AC, Shamban J, O’Riordan DL, et al. Raising sun protection and early detection awareness among Florida high schoolers. Pediatr Dermatol. 2005; 22 (2): 112–8

    Article  PubMed  Google Scholar 

  26. Neale R, Williams G, Green A. Application patterns among participants randomized to daily sunscreen use in a skin cancer prevention trial. Arch Dermatol. 2002; 138: 1319–25

    Article  PubMed  Google Scholar 

  27. Seuker DC, Newstead CG, Cunliffe WJ. The compliance of renal transplant recipients with advice about sun protection measures. Br J Dermatol. 1998; 138: 301–3

    Article  Google Scholar 

  28. Robinson JK. Behavior modification obtained by sun protection education coupled with removal of a skin cancer. Arch Dermatol. 1990; 126 (4): 477–81

    Article  PubMed  CAS  Google Scholar 

  29. Freiman A, Yu J, Loutfi A, et al. Impact of melanoma diagnosis on sun-awareness and protection: efficacy of education campaigns in a high-risk population. J Cut Med Surg. 2004 Sep/Oct; 8 (5): 303–9

    Article  Google Scholar 

  30. Koehler AM, Maibach HI. Electronic monitoring in medication adherence measurement: implications for dermatology. Am J Clin Dermatol. 2001; 2 (1): 7–12

    Article  PubMed  CAS  Google Scholar 

  31. Epstein E. Common skin disorders: a physician’s illustrated manual with patient instruction sheets. Oradell (NJ): Medical Economics Books, 1998

    Google Scholar 

  32. Chren MM, Lasek RJ, Flocke SA, et al. Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases. Arch Dermatol. 1997; 133: 1433–40

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Dermatology, University of California, School of Medicine, Box 0989, Surge 110, 90 Medical Center Way, San Francisco, California, 94143-0989, USA

    Howard I. Maibach

Authors
  1. Howard I. Maibach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Howard I. Maibach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maibach, H.I. Pharmionics in Dermatology. Am J Clin Dermatol 7, 231–236 (2006). https://doi.org/10.2165/00128071-200607040-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128071-200607040-00004

Keywords

Search

Navigation