Medical adherence to topical corticosteroid preparations prescribed for psoriasis: A systematic review

Regular support provided by dermatological nurses improves outcomes in patients with psoriasis treated with topical drugs: a randomized controlled trial

BACKGROUND

Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long-term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome.

AIM

To evaluate whether regular support from dermatological nurses improves outcome and treatment adherence in patients with psoriasis receiving topical medications.

METHODS

We conducted a randomized controlled trial (RCT) (clinicaltrials.gov registration NCT04220554), in which patients received once-daily topical medications (containing corticosteroids and/or calcipotriol) for as long as their psoriasis was visible. The patients were randomly allocated to standard care by the dermatologist either with (n = 51) or without (n = 52) support from dermatological nurses. The nurse support intervention consisted of a structured dermatological consultation at baseline and Week 1, followed by contact with a nurse each month (in the outpatient clinic or by telephone). The primary outcome was severity of psoriasis, which was measured by the Lattice System Physician's Global Assessment (LS-PGA) and assessed by intention-to-treat analyses using linear mixed regression models for longitudinal data. Secondary outcomes were quality of life (measured by the Dermatology Life Quality Index; DLQI) and good adherence (defined as use of ≥ 80% of recommended doses).

RESULTS

In total, 92 patients (89%) completed the 48-week trial period. The intervention group improved more than the nonintervention group from baseline to Week 24 in LS-PGA (2.21 vs. 1.28, P = 0.001) and in DLQI at Week 12 (6.50 vs. 1.55, P < 0.001). Differences between the two groups in favour of the intervention were observed throughout the study period. More participants in the intervention group had good adherence compared with the nonintervention group (36% vs. 14%, P < 0.001).

CONCLUSION

Regular, continued patient support from dermatological nurses increased the efficacy of psoriasis treatment, improved quality of life and enhanced long-term adherence to topical antipsoriatic drugs. However, there is still room for more improvement.

Health literacy and medication adherence in psoriasis patients: a survey in Iran

BACKGROUND

Medication adherence among Psoriasis patients is often inadequate identified as a significant problem in Psoriasis symptoms management. Poor medication adherence could necessitate stronger and more expensive medications, which could place a significant burden on the healthcare system. Moreover, the importance of health literacy assessment as a factor influencing adherence in psoriasis patients cannot be overstated. This study aimed to evaluate the medication adherence level of Iranian Psoriasis patients and its relationship with the patients' health literacy level and demographic conditions.

METHODS

This is a cross-sectional study among Iranian psoriasis patients conducted through a web-based questionnaire survey between 26 July 2020 and 5 January 2021 and a total of 575 samples were collected. The questionnaire consisted of 3 sections: First, demographic information and disease characteristics were evaluated. Second, the medication adherence was evaluated by using valid Morisky Medication Adherence Scale-8 (MMAS-8), and, finally, the health literacy was evaluated by using Health Literacy for Iranian Adults (HELIA). Data were analyzed using SPSS software, version 22 with descriptive statistics; Chi-square and Kruskal-Wallis tests. Stepwise multiple linear regression was also used to evaluate the impact of independent variables related on medication adherence score.

RESULTS

Results showed that the mean health literacy score in the study population was 74.3 ± 14.23, and the mean medication adherence score was 4.1 ± 2.18. Out of the total participants, 28.8% had high health literacy, 67.1% had adequate health literacy, and 4% had inadequate health literacy. The majority of the participants (70.7%) reported low adherence, while 24.1% reported moderate and 5.2% reported high adherence. The results of the Chi-square test showed a significant relationship between age, comorbidities, type of treatment, satisfaction with treatment, the experience of adverse effects, and health literacy with medication adherence (P < 0.05 for all). The final constructed model of stepwise multiple linear regression was highly statistically significant. The highest beta coefficient in the final model belonged to the total health literacy score.

CONCLUSIONS

Based on the results, medication adherence among Iranian psoriasis patients is low. Health literacy correlates most strongly with medication adherence and is the best variable to determine it. Improving the access to the internet and the ICTs to enhance the patients` health literacy along with developing the patient education approaches and techniques should be considered by health policymakers.

Topical treatment adherence and associated factors in patients with psoriasis: a single centre, cross-sectional study

BACKGROUND

Topical medications are one of the main treatments for psoriasis. Adherence to treatment is an important factor in achieving successful control of disease. The aim of this study was to evaluate adherence to topical drugs and identify possible associated factors in in patients with psoriasis.

METHOD

Ninety-three patients were evaluated by a two-part questionnaire; The first part examined demographic, socioeconomic and disease-related factors while the second part, the ECOB questionnaire (Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux), examined adherence to topical drugs.

RESULTS

The mean self-reported adherence to topical treatment in this study, was 50.5%. Severe disease, involvement of lower extremity, and positive family history of psoriasis were associated with poor adherence to treatment. Patients with a history of diabetes mellitus had better adherence to treatment.

CONCLUSION

In this study adherence to topical treatment was low and had no significant relationship with most of the studied demographic and socioeconomic factors. This article is protected by copyright. All rights reserved.

Validation of the Self-Reported Psoriasis Treatment Convenience Scale (PTCS)

INTRODUCTION

Adherence to topical treatments for psoriasis is reported to be poor. One key contributing factor is the inconvenience associated with formulations that may be greasy, time consuming to apply, and slow to absorb. There is a paucity of patient-reported outcome measures that evaluate psoriasis patients' perceptions of treatment convenience. The Psoriasis Treatment Convenience Scale (PTCS) was therefore developed and validated.

METHODS

Following a literature review of issues relating to convenience of topical treatments, important items were identified and a draft version of the PTCS was developed and underwent content validity testing (n = 20). The revised scale was included in a clinical trial of topical therapy (n = 794; NCT03308799), and psychometric testing was performed.

RESULTS

The final questionnaire included five core items and one overall satisfaction question. In psychometric testing, the scale demonstrated stability across trial population, and good validity, reliability, and sensitivity.

CONCLUSION

The PTCS is a new, reliable, sensitive, validated tool for the assessment of patient-reported treatment convenience. Use of the PTCS will facilitate evaluation of convenience as part of the clinical development of topical therapies, and thus may help to improve patient adherence and, therefore, treatment outcomes.

Long-term improvement of psoriasis patients' adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

BACKGROUND

Psoriasis affects 2-4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure.

METHODS

The intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure. The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18-85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol. The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician's Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants' total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out.

DISCUSSION

If the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04220554 . Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov . Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.

A pooled analysis of randomized, controlled, phase 3 trials investigating the efficacy and safety of a novel, fixed dose calcipotriene and betamethasone dipropionate cream for the topical treatment of plaque psoriasis

BACKGROUND

Plaque psoriasis is a common, chronic and relapsing inflammatory skin disease clinically characterized by erythema and scaling desquamation. As over 90% of psoriasis patients benefit from topical therapies, local treatments continue to play an eminent role in management strategies. One such topical treatment is the fixed dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP).

OBJECTIVES

Pooled analysis of two different phase 3 clinical trails to compare superiority regarding efficacy, safety and quality of life (QoL) between CAL/BDP PAD-cream and CAL/BDP TS.

METHODS

The data from two phase 3, multicentre, randomized, investigator-blind, active and vehicle-controlled trials enrolling patients with psoriasis were pooled and analysed. Investigational products included a CAL/BDP cream based on PAD™ Technology (PAD-cream) designed for high skin penetration and increased patient preference, an active control (marketed CAL/BDP topical suspension/gel, in the following abbreviated as CAL/BDP TS) and cream vehicle, which were applied once daily for 8 weeks.

RESULTS

Efficacy and safety of the novel CAL/BDP PAD-cream formulation for the topical treatment of psoriasis demonstrated superiority for all efficacy end points after 8 weeks of treatment. PGA treatment success for CAL/BDP PAD-cream (43.2%) was greater than CAL/BDP TS (31.9%; P < 0.0001), the mean per cent reduction in mPASI for CAL/BDP PAD-cream was 64.6% compared to 56.4% for CAL/BDP TS (P < 0.0001) and DLQI 0/1 was obtained by 43.8% in the CAL/BDP PAD-cream group versus 34.2% in the CAL/BDP TS group (P = 0.0005). There was no adverse drug reaction reported with a frequency of >1%, associated with the CAL/BDP PAD-cream.

CONCLUSIONS

The novel fixed dose combination CAL/BDP PAD-cream offers greater efficacy, superior patient QoL and equivalent favourable safety for the topical treatment of psoriasis, in comparison to the currently available topical suspension/gel.

Nonadherence to Treatment and Patient-Reported Outcomes of Psoriasis During the COVID-19 Epidemic: A Web-Based Survey

PURPOSE

The COVID-19 epidemic has caused difficulties in continuous treatment for patients with chronic diseases and resulted in nonadherence to treatment and adverse health outcomes. This study aimed to investigate the associations of nonadherence to treatment with patient-reported outcomes of psoriasis during the COVID-2019 epidemic.

METHODS

A cross-sectional study among Chinese patients with psoriasis was conducted through a web-based questionnaire survey during 25 Feb 2020 and 6 Mar 2020. Demographic and clinical data, nonadherence to treatment, and patient-reported outcomes were collected. The outcomes included deterioration of the disease condition, perceived stress, and symptoms of anxiety and depression. Logistic regression was used to investigate the associations.

RESULTS

A total of 926 questionnaires were collected. A total of 634 (68.5%) reported nonadherence to treatment, and worse adherence was found among patients receiving systemic treatment (adjusted odds ratio [AOR]: 2.67; 95% CI: 1.40-5.10) and topical treatment (AOR: 4.51; 95% CI: 2.66-7.65) compared to biological treatment. Nonadherence to treatment (less than two weeks and more than two weeks) was significantly associated with deterioration of psoriasis (aOR: 2.83 to 5.25), perceived stress (AOR: 1.86 to 1.57), and symptoms of anxiety (AOR: 1.42 to 1.57) and depression (AORs: 1.78). Subgroup analysis by treatment showed consistent results in general.

CONCLUSION

Nonadherence to treatment was associated with the aggravation of psoriasis conditions, perceived stress, and symptoms of anxiety and depression.

Psychological Therapies in Management of Psoriatic Skin Disease: A Systematic Review

BACKGROUND

Psoriasis is a chronic, immune-mediated skin disease shown to have a multifaceted relationship with psychological factors. Because these factors have been shown to both worsen and result from psoriasis, an increasing number of studies have sought to investigate the efficacy of various psychological interventions in psoriasis management.

METHODS

A systematic review of PubMed^® and Scopus^® databases was performed for studies investigating psychological interventions in psoriasis management published from 1 January 1990 through 4 November 2018. Primary articles published in English and conveying physical treatment outcomes were included, whereas articles not describing clinical outcomes were excluded. Studies supporting intervention efficacy were graded with a level of evidence according to the Scottish Intercollegiate Guidelines Network levels of evidence.

RESULTS

A total of 28 reports studying 27 unique sets of patients receiving psychological therapies in psoriasis management were identified, including three case reports and series and 24 clinical trials, investigating 1522 patients in total. Cognitive behavioral therapy and its variants, biofeedback, meditation and mindfulness-based therapies, hypnosis, music resonance therapy, motivational interviewing, emotional disclosure, and educational and multidisciplinary approaches have been studied in the treatment of psoriasis. Although 16 randomized controlled trials were included in this review, literature is limited by heterogeneity of methodology, analyses, and outcomes. Only 4 of 27 studies (three of which investigated cognitive behavioral therapy) were rated a level of evidence of 1+ or greater. Studies, overall, have sample sizes often < 50 patients, lack follow-up past 12 months, and have attrition rates > 20%.

CONCLUSIONS

Based on assigned levels of evidence, the most promising methods of psychological intervention in psoriasis include cognitive behavioral therapy, mindfulness-based therapies, motivational interviewing, and educational and interdisciplinary interventions. Further study is needed to determine the efficacy, practicality, and economic feasibility of these treatment options for patients with psoriasis.

Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam For Scalp Psoriasis

This article presents real-world experience of the effectiveness of calcipotriol (50 µg/g)/betamethasone dipropionate (0.5 mg/g) (Cal/BD) aerosol foam formulation in three cases of scalp psoriasis, and briefly reviews the literature relating to Cal/BD topical therapy in adults with scalp psoriasis. Patients had long histories of scalp psoriasis and reported negative impacts on their lives (e.g. clothing choices, psychological well-being, employment status). Previous treatments had provided inadequate or only temporary relief. Cal/BD aerosol foam relieved itching in the first few days and was associated with visible improvement of flaky patches on the scalp at the end of the recommended 4-week treatment period. Controlled clinical trials in patients with scalp psoriasis are rare. There have been several trials in adults with scalp psoriasis involving Cal/BD gel or suspension scalp formulations, which have proven more effective and well tolerated compared with the individual components or vehicle alone. The Cal/BD aerosol formulation has enhanced skin penetration and higher bioavailability compared with the older formulations; studies show improved efficacy with Cal/BD aerosol foam, compared with older formulations, in patients with plaque psoriasis. The present cases confirm the benefits of Cal/BD aerosol foam in adults with scalp psoriasis, treated in real-world settings.

Improving psoriasis patients' adherence to topical drugs: a systematic review

Background: Poor adherence to topical antipsoriatic drugs limits treatment effectiveness.Objective: The aim of this study was to investigate how health care providers may improve psoriasis patients' adherence to topical treatment.Materials and methods: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library.Results: Ten studies of varying quality were identified. Two randomized controlled trials (RCTs) testing the adherence-improving potential of interventions by health care providers to support patients showed improvement in adherence to topical treatment. In a prospective study with a pre/postdesign, an individualized, face-to-face consultation reported an improvement in patient-reported adherence to topical treatment over a 9-week period. Based on seven qualitative studies obtaining insights from either patients or health care providers, health care providers may need to address socio-economic factors, health care system factors, and treatment-, patient-, and disease-related factors in interventions that aim to improve the adherence of psoriasis patients to topical antipsoriatic drugs.Conclusion: There is a need to develop better adherence-improving interventions. A good patient-health care provider relationship is considered crucial to adherence and may be an important intervention target. Before interventions to improve adherence to topicals can be recommended for the clinic, the intervention should be tested in high-quality RCTs.

Calcipotriol/betamethasone dipropionate aerosol foam for the treatment of psoriasis vulgaris: case series and review of the literature

An aerosol foam formulation of a once-daily, fixed-dose combination of a synthetic vitamin D₃ analog/synthetic corticosteroid (calcipotriol [Cal] 50 µg/g and betamethasone dipropionate [BD] 0.5 mg/g) has recently been introduced for the topical treatment of plaque psoriasis in adults. Data from several sources - randomized controlled trials, case reports (as highlighted in this review), and real-world evidence (RWE) - underscore the considerable and rapid clinical response, effectiveness, and favorable safety and tolerability of Cal/BD aerosol foam in mild-to-moderate psoriatic patients previously treated with class 3 or 4 topical corticosteroids, in patients unsatisfied with ongoing phototherapy in combination with topical therapy and in patients with moderate-to-severe psoriasis. In addition, our case series, considered together with other RWE, highlights that Cal/BD aerosol foam is more effective and with greater levels of patient preference and acceptability than comparator preparations. Thus, Cal/BD aerosol foam offers several treatment advantages, including relief of itch, and is an appropriate first-line topical therapy for consideration in patients with psoriasis of any severity.

A smartphone application supporting patients with psoriasis improves adherence to topical treatment: a randomized controlled trial

BACKGROUND

Adherence to topical psoriasis treatments is low, which leads to unsatisfactory treatment results. Smartphone applications (apps) for patient support exist but their potential to improve adherence has not been systematically evaluated.

OBJECTIVES

To evaluate whether a study-specific app improves adherence and reduces psoriasis symptoms compared with standard treatment.

METHODS

We conducted a randomized controlled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once-daily medication [calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app intervention (n = 68) groups. In total, 122 patients (91%) completed the 22-week follow-up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS-PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits.

RESULTS

Intention-to-treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/BD cutaneous foam than those in the nonintervention group at week 4 (65% vs. 38%, P = 0·004). The intervention group showed a greater LS-PGA reduction than the nonintervention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance.

CONCLUSIONS

This RCT demonstrates that the app improved short-term adherence to Cal/BD cutaneous foam treatment and psoriasis severity.

Canadian Patients' Preferences in Topical Psoriasis Care: Insights From the PROPEL Surveys

BACKGROUND

Patients with psoriasis of all severities employ topical treatment, either alone or in combination. Promoting Patient Engagement at the Leading Edge of Topical Psoriasis Treatment (PROPEL) surveyed Canadian dermatologists and their patients about their attitudes toward topical care.

OBJECTIVES

To identify gaps between patients and dermatologists regarding the burden of psoriasis, the burden of treatment, and priorities for topical care to Canadian patients with psoriasis.

METHODS

Two parallel surveys explored patient attitudes toward psoriasis and their experience with topical care, as expressed by patients or as perceived by their dermatologists. A third survey, addressed to patients, included additional questions regarding treatment adherence to current topical treatment regimens.

RESULTS

PROPEL dermatologists underestimated the burden associated with psoriatic itch. Otherwise, they were well aligned with patients' views, including their preference for maintaining topical care of their psoriasis over other treatment modalities, the nature of good psoriasis control, and desirable features of topical medications. Despite holding generally positive views of topical therapy, many patients self-identified as poorly adherent.

CONCLUSIONS

Long-term adherence to psoriasis topical care remains a challenge. Formulations with improved acceptability might help patients maintain good adherence.

Can an app supporting psoriasis patients improve adherence to topical treatment? A single-blind randomized controlled trial

Background

Topical corticosteroid or corticosteroid/calcipotriol preparations are recommended first-line topical treatments of psoriasis, but a main cause for the lack of efficacy of topical treatments is considered low rates of adherence to topical drugs. Patient support by the use of applications (apps) for smartphones is suggested to improve medical adherence.

Methods/design

Design: An investigator-initiated, single-center, single-blind, parallel-group, phase-4 clinical superiority randomized controlled trial (RCT). Participants: 134 patients 18 to 75 years of age with mild-to-moderate psoriasis, who are capable of reading English language, own a smartphone, and are candidates for the study drug calcipotriol and betamethasone dipropionate (Cal/BD) cutaneous foam once daily prn (pro re nata). Intervention: A 28-day adherence-supporting app providing compulsory daily treatment reminders that pop-up on the smartphone screen with a short alert sound. The app synchronizes through Bluetooth® to an electronic monitor (EM) attached to the medication canister. The EM contains a chip registering the amount of foam, day and time the patient use the foam dispenser. The information is displayed in a diary that shows the amount of Cal/BD cutaneous foam used and the number of applied treatment sessions. The app has an optional diary with the patient’s rating of symptoms. Non-intervention: Use of Cal/BD cutaneous foam and EM without the app. All participants are prescribed Cal/BD cutaneous foam prn for the entire study period.

Primary outcome obtained in week 4: rates of adherence measured by patient report, weight of medication canisters, and number of treatment sessions measured by the EM. Secondary outcomes obtained at baseline, weeks 4, 8, and 26: Lattice System Physician’s Global Assessment (LS-PGA) and Dermatology Quality of Life Index (DLQI).

Discussion

This trial tests of whether an app can improve rates of adherence to a topical antipsoriatic drug. If the app improves rates of adherence and reduces the burden of psoriasis in a clinically significant way, the app could easily be implemented as a standard routine of care in the clinic.

Trial registration

NCT02858713, registered on August 3, 2016. EudraCT number 2016–002143-42.

Electronic supplementary material

The online version of this article (10.1186/s12895-018-0071-3) contains supplementary material, which is available to authorized users.

Development and Validation of a Novel Questionnaire for Adherence with Topical Treatments in Psoriasis (QATOP)

BACKGROUND

Self-report measures are the most used methodologies for the evaluation of adherence to psoriasis topical treatment, although currently there is no standard questionnaire for this purpose.

OBJECTIVE

The present study aimed at developing a novel questionnaire (Questionnaire for Adherence to TOPical treatment [QATOP]) for the assessment of adherence to topical treatment in psoriasis.

METHODS

A questionnaire containing nine items organized into two parts (part 1: current patient treatment; part 2: adherence to treatment, amount used, and treatment-associated variables) was developed, supported by a systematic literature review, qualitative patient focus interviews, and expert-group input. Its content validity was determined by a pilot study of six patients. Adherence to topical treatment was then assessed in 35 patients with psoriasis, after 45 days of treatment, using the QATOP and a medication log. Associations between different items of the QATOP and the log were investigated.

RESULTS

Adherence results were 63.5 ± 29.2% for the log and 60.9 ± 24.4% for the QATOP, and were strongly correlated (R = 0.819, p < 0.001). Distinct posologic regimens were reported by patients, which, in some cases, were not the usual doses. Patients also reported using doses of medicine on each application that were markedly lower than required.

CONCLUSION

The QATOP is a valid and reliable self-report measure of adherence to topical treatment in patients with psoriasis. The use of this standard questionnaire could improve the methodological quality of adherence studies. Improvement of the clarity of posologic instructions is clearly urgently needed.

Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review

OBJECTIVE

To review published literature describing the global use of topical antipsoriatics.

MATERIALS AND METHODS

Search for English-language articles in Embase, Pubmed, PsycINFO and Cochrane Library.

RESULTS

Fifty-four selected publications were found, describing psoriasis patients' use of topical antipsoriatics, using six different methods to collect data. The eight most frequently used topical treatments from the regions North/South America, North/Central/South Europe, Asia, Middle East and Australia were: corticosteroids used by 16-79%, complementary and alternative medicines used by 10-62%, phototherapies used by 0.4-75%, calcipotriol used by 4.2-73%, corticosteroid/calcipotriol combinations used by 3.3-71%, tar used by 0.8-66%, anthralin used by 15% and emollients used as monotherapy by 1-23%. Rates of patient-reported adherence to topical remedies ranged from 51% to 90% and rates of patient-reported satisfaction with topical as it pertains to symptom control ranged from 12% to 52%.

CONCLUSION

The identified use patterns are varying and reflect a lack of data from large parts of the world and noncomparable studies using heterogeneous study designs. However, this study emphasizes the importance of medical professionals involvement of the patient with respect to choosing prescribed topical treatment and the possibility of patients' use of alternative treatments. More drug utilization studies, both survey and register based, from different parts of the world are needed to provide more conclusive evidence about patients' use of topical antipsoriatics.