Maximizing Treatment Compliance in Psoriasis

  • Kody Heubach
  • Leah A. CardwellEmail author
  • Steven R. Feldman
Part of the Updates in Clinical Dermatology book series (UCD)


Psoriasis affects millions of people in the United States. While there is no cure, treatment can control the disease and improve patients’ quality of life. Regardless of the chosen treatment type, adherence is paramount. Nonadherence to treatment results in an estimated over $100 billion dollars in healthcare costs annually in the United States. One-third of psoriasis patients admit to not following the prescribed medication regimen; often, prescriptions for psoriasis are not even filled. Adherence may be measured through modalities such as patient report, electronic monitoring, or medical record query. Multiple factors may affect treatment adherence in psoriasis patients. Strategies to improve adherence are developed to address these factors. Optimizing physician-patient rapport is the foundation of adherence improvement strategies. Timing of office visits, written instructions, and reassurance concerning side effects are other basic strategies. In psoriasis management, it is just as important to ensure that patients adhere to the prescribed regimen as it is to choose the best treatment plan.


Psoriasis Compliance Adherence Topicals Systemics Phototherapy Biologics Monitoring 


  1. 1.
    Balkrishnan R, Carroll CL, Camacho FT, Feldman SR. Electronic monitoring of medication adherence in skin disease: results of a pilot study. J Am Acad Dermatol. 2003;49(4):651.CrossRefPubMedGoogle Scholar
  2. 2.
    Brown KK, Rehmus WE, Kimball AB. Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis. J Am Acad Dermatol [Internet]. 2006;55:607–13. CrossRefPubMedGoogle Scholar
  3. 3.
    Carroll CL, Feldman SR, Camacho FT, Balkrishnan R. Better medication adherence results in greater improvement in severity of psoriasis. Br J Dermatol. 2004;151:895–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Storm A, Andersen SE, Benfeldt E, Serup J. One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic. J Am Acad Dermatol [Internet]. 2008 [cited 2017 Mar 16];59:27–33. Scholar
  5. 5.
    Anderson KL, Dothard EH, Huang KE, Feldman SR. Frequency of primary nonadherence to acne treatment. JAMA Dermatol [Internet]. American Medical Association; 2015 [cited 2017 Apr 15];151:623. CrossRefPubMedGoogle Scholar
  6. 6.
    Solomon MD, Majumdar SR. Primary non-adherence of medications: lifting the veil on prescription-filling behaviors. J Gen Intern Med [Internet]. Springer; 2010 [cited 2017 Apr 15];25:280–1. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Schneider MP, Krummenacher I, Figueiredo H, Marquis J, Bugnon O. Adherence: a review of education, research, practice and policy in Switzerland. Pharm Pract (Granada) [Internet]. Centro de Investigaciones y Publicaciones Farmaceuticas; 2009 [cited 2017 Apr 15];7:63–73.
  8. 8.
    Hugtenburg JG, Timmers L, Elders PJ, Vervloet M, van Dijk L. Patient preference and adherence definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Prefer Adherence [Internet]. 2013 [cited 2017 Apr 15];7:675–82.
  9. 9.
    Simpson JK, Wilson M, Ahmed AA, Mizara A, Clarke A, Mcbride SR. An exploratory study to investigate health-seeking behaviour in patients with psoriasis using framework analysis. Br J Dermatol [Internet]. 2017 [cited 2017 Mar 16];
  10. 10.
    Sandoval LF, Huang KE, Feldman SR. Adherence to ustekinumab in psoriasis patients. J Drugs Dermatol [Internet]. 2013 [cited 2017 Mar 16];12:1090–2.
  11. 11.
    Storm A, Benfeldt E, Andersen SE, Andersen J. Basic drug information given by physicians is deficient, and patients’ knowledge low. J Dermatol Treat [Internet]. 2009 [cited 2017 Apr 12];20:190–3. CrossRefPubMedGoogle Scholar
  12. 12.
    Storm A, Benfeldt E, Andersen SE, Serup J. A prospective study of patient adherence to topical treatments: 95% of patients underdose. J Am Acad Dermatol [Internet]. 2008 [cited 2017 Apr 12];59:975–80. CrossRefPubMedGoogle Scholar
  13. 13.
    Iversen L, Jakobsen HB. Patient preferences for topical psoriasis treatments are diverse and difficult to predict. Dermatol Ther (Heidelb) [Internet]. 2016 [cited 2017 Mar 16];6:273–85.
  14. 14.
    Tan X, Feldman SR, Chang J, Balkrishnan R. Topical drug delivery systems in dermatology: a review of patient adherence issues. Expert Opin Drug Deliv [Internet]. 2012 [cited 2017 Mar 16];9:1263–71. CrossRefPubMedGoogle Scholar
  15. 15.
    Fisher EJ, Adams BB. African American and Caucasian patients’ vehicle preference for the scalp. J Am Acad Dermatol [Internet]. 2008 [cited 2017 Apr 17];58:S46–7. CrossRefPubMedGoogle Scholar
  16. 16.
    Koek MBG, Buskens E, van Weelden H, Steegmans PHA, Bruijnzeel-Koomen CAFM, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ [Internet]. 2009 [cited 2017 Mar 16];338:b1542. Scholar
  17. 17.
    Cheng J, Feldman SR. The cost of biologics for psoriasis is increasing. Drugs Context [Internet]. JUST Medical Media Limited; 2014 [cited 2017 Mar 16];3:212266. CrossRefGoogle Scholar
  18. 18.
    Aslam I, Feldman SR. Practical strategies to improve patient adherence to treatment regimens. South Med J [Internet]. 2015 [cited 2017 Mar 16];108:325–31.
  19. 19.
    Hsu DY, Gniadecki R. Patient adherence to biologic agents in psoriasis. Dermatology [Internet]. 2016 [cited 2017 Mar 16];232:326–33. CrossRefPubMedGoogle Scholar
  20. 20.
    Hoffman MB, Hill D, Feldman SR. Current challenges and emerging drug delivery strategies for the treatment of psoriasis. Expert Opin Drug Deliv [Internet]. 2016 [cited 2017 Mar 16];13:1461–73. CrossRefPubMedGoogle Scholar
  21. 21.
    Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J [Internet]. Oman Medical Specialty Board; 2011 [cited 2017 Apr 15];26:155–9. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Adisa R, Alutundu MB, Fakeye TO. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria. Pharm Pract (Granada) [Internet]. 2009 [cited 2017 Apr 15];7:163–9.
  23. 23.
    Khan MU, Shah S, Hameed T. Barriers to and determinants of medication adherence among hypertensive patients attended National Health Service Hospital, Sunderland. J Pharm Bioallied Sci [Internet]. Medknow Publications; 2014 [cited 2017 Apr 15];6:104–8. CrossRefPubMedGoogle Scholar
  24. 24.
    Nguyen T V., Hong J, Prose NS. Compassionate care: enhancing physician–patient communication and education in dermatology: Part I: Patient-centered communication. J Am Acad Dermatol [Internet]. 2013 [cited 2017 Apr 18];68:353.e1–353.e8. CrossRefGoogle Scholar
  25. 25.
    Renzi C, Abeni D, Picardi A, Agostini E, Melchi CF, Pasquini P, et al. Factors associated with patient satisfaction with care among dermatological outpatients. Br J Dermatol [Internet]. 2001 [cited 2017 Apr 18];145:617–23. CrossRefPubMedGoogle Scholar
  26. 26.
    Renzi C, Picardi A, Abeni D, Agostini E, Baliva G, Pasquini P, et al. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol [Internet]. 2002 [cited 2017 Apr 18];138:337–42.
  27. 27.
    Carroll CL, Feldman SR, Camacho FT, Manuel JC, Balkrishnan R. 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 [Internet]. 2004 [cited 2017 Mar 16];51:212–6. CrossRefPubMedGoogle Scholar
  28. 28.
    Alinia H, Moradi Tuchayi S, Smith JA, Richardson IM, Bahrami N, Jaros SC, et al. Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring. Br J Dermatol [Internet]. 2016 [cited 2017 Mar 16];
  29. 29.
    Woolf RT, West SL, Arenas-Hernandez M, Hare N, Peters van Ton AM, Lewis CM, et al. Methotrexate polyglutamates as a marker of patient compliance and clinical response in psoriasis: a single-centre prospective study. Br J Dermatol [Internet]. 2012 [cited 2017 Mar 16];167:165–73. CrossRefPubMedGoogle Scholar
  30. 30.
    Doshi JA, Takeshita J, Pinto L, Li P, Yu X, Rao P, et al. Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population. J Am Acad Dermatol [Internet]. 2016 [cited 2017 Mar 16];74:1057–1065.e4. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    West C, Narahari S, O’Neill J, Davis S, Huynh M, Clark A, et al. Adherence to adalimumab in patients with moderate to severe psoriasis. Dermatol Online J [Internet]. 2013 [cited 2017 Apr 12];19:18182.
  32. 32.
    Yelverton CB, Balkrishnan R, Feldman SR. The utility of a data-logging device for measuring adherence to home phototherapy. Photodermatol Photoimmunol Photomed [Internet]. 2006 [cited 2017 Mar 16];22:270–2. CrossRefPubMedGoogle Scholar
  33. 33.
    Fouere S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol [Internet]. 2005 [cited 2017 Mar 16];19:2–6. CrossRefPubMedGoogle Scholar
  34. 34.
    Chan SA, Hussain F, Lawson LG, Ormerod AD. Factors affecting adherence to treatment of psoriasis: comparing biologic therapy to other modalities. J Dermatol Treat [Internet]. 2013 [cited 2017 Mar 16];24:64–9. CrossRefPubMedGoogle Scholar
  35. 35.
    Furue M, Onozuka D, Takeuchi S, Murota H, Sugaya M, Masuda K, et al. Poor adherence to oral and topical medication in 3096 dermatological patients as assessed by the Morisky Medication Adherence Scale-8. Br J Dermatol [Internet]. Wiley-Blackwell; 2015 [cited 2017 Apr 18];172:272–5. CrossRefPubMedGoogle Scholar
  36. 36.
    Saeki H, Imafuku S, Abe M, Shintani Y, Onozuka D, Hagihara A, et al. Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients. J Dermatol [Internet]. 2015 [cited 2017 Apr 18];42:367–72. CrossRefPubMedGoogle Scholar
  37. 37.
    Yentzer BA, Yelverton CB, Pearce DJ, Camacho FT, Makhzoumi Z, Clark A, et al. Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis. J Am Acad Dermatol [Internet]. 2008 [cited 2017 Mar 16];59:577–81. CrossRefPubMedGoogle Scholar
  38. 38.
    Kalia S, Toosi B, Bansback N, Astaneh A, Zhou Y, Shapiro J, et al. Assessing adherence with phototherapy protocols. J Am Acad Dermatol [Internet]. Elsevier; 2014 [cited 2017 Apr 19];71:1259–61. CrossRefPubMedGoogle Scholar
  39. 39.
    Szabó C, Kemény L, Csabai M. Dermatology patients’ and their doctors’ representations about adherence. Open Med. (Warsaw, Poland) [Internet]. De Gruyter Open; 2015 [cited 2017 Apr 19];10:216–23.
  40. 40.
    Wagner GJ, Ryan GW. Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users. AIDS Patient Care STDS [Internet]. 2004 [cited 2017 Apr 19];18:385–93. CrossRefPubMedGoogle Scholar
  41. 41.
    Hill D, Farhangian ME, Feldman SR. Increasing adherence to topical therapy in psoriasis through use of solution medication. Dermatol Online J [Internet]. 2016 [cited 2017 Mar 16];22.
  42. 42.
    Skojec A, Foulke G, Kirby JS. Variation in the cost of generic topical corticosteroids. JAMA Dermatol [Internet]. American Medical Association; 2015 [cited 2017 Apr 19];151:1255. CrossRefPubMedGoogle Scholar
  43. 43.
    Podsadecki TJ, Vrijens BC, Tousset EP, Rode RA, Hanna GJ. “White coat compliance” limits the reliability of therapeutic drug monitoring in HIV-1—infected patients. HIV Clin Trials [Internet]. 2008 [cited 2017 Apr 19];9:238–46. CrossRefPubMedGoogle Scholar
  44. 44.
    Feldman SR, Camacho FT, Krejci-Manwaring J, Carroll CL, Balkrishnan R. Adherence to topical therapy increases around the time of office visits. J Am Acad Dermatol [Internet]. 2007 [cited 2017 Apr 19];57:81–3. CrossRefPubMedGoogle Scholar
  45. 45.
    Khoury LR, Skov L, Møller T. Facing the dilemma of patient-centred psoriasis care: a qualitative study identifying patient needs in dermatological outpatient clinics. Br J Dermatol [Internet]. 2016 [cited 2017 Mar 16];
  46. 46.
    Homer D, Nightingale P, Jobanputra P. Providing patients with information about disease-modifying anti-rheumatic drugs: Individually or in groups? A pilot randomized controlled trial comparing adherence and satisfaction. Musculoskeletal Care [Internet]. 2009 [cited 2017 Apr 19];7:78–92. CrossRefPubMedGoogle Scholar
  47. 47.
    Dilorio C, Resnicow K, McDonnell M, Soet J, McCarty F, Yeager K. Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study. J Assoc Nurses AIDS Care [Internet]. 2003 [cited 2017 Mar 16];14:52–62.
  48. 48.
    Kemp R, Hayward P, Applewhaite G, Everitt B, David A. Compliance therapy in psychotic patients: randomised controlled trial. BMJ [Internet]. BMJ Group; 1996 [cited 2017 Apr 19];312:345–9. CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Tran N, Coffman JM, Sumino K, Cabana MD. Patient reminder systems and asthma medication adherence: a systematic review. J Asthma [Internet]. 2014 [cited 2017 Mar 16];51:536–43. CrossRefPubMedGoogle Scholar
  50. 50.
    Balato N, Megna M, Di Costanzo L, Balato A, Ayala F. Educational and motivational support service: a pilot study for mobile-phone-based interventions in patients with psoriasis. Br J Dermatol [Internet]. 2013 [cited 2017 Apr 19];168:201–5. CrossRefPubMedGoogle Scholar
  51. 51.
    Petersen ML, Wang Y, van der Laan MJ, Guzman D, Riley E, Bangsberg DR. Pillbox organizers are associated with improved adherence to HIV antiretroviral therapy and viral suppression: a marginal structural model analysis. Clin Infect Dis [Internet]. 2007 [cited 2017 Mar 16];45:908–15. CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Gooderham M, Papp K. Apremilast in the treatment of psoriasis and psoriatic arthritis. Skin Therapy Lett [Internet]. [cited 2017 Mar 16];20:1–6.
  53. 53.
    Kerdel F, Zaiac M. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals. Dermatol Ther [Internet]. 2015 [cited 2017 Apr 20];28:390–403. CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Nolan B V, Yentzer BA, Feldman SR. A review of home phototherapy for psoriasis. Dermatol Online J [Internet]. 2010 [cited 2017 Mar 16];16:1.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kody Heubach
    • 1
  • Leah A. Cardwell
    • 2
    Email author
  • Steven R. Feldman
    • 2
    • 3
    • 4
  1. 1.LumbertonUSA
  2. 2.Department of DermatologyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of PathologyWake Forest School of MedicineWinston-SalemUSA
  4. 4.Department of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA

Personalised recommendations