Abstract
Poor adherence to treatment is a major factor limiting treatment outcomes in patients with atopic dermatitis. The purpose of our systematic review is to identify techniques that have been tested to increase treatment adherence in atopic dermatitis. A MEDLINE search was performed for clinical trials focusing on interventions used to increase adherence in atopic dermatitis. Four articles were retrieved. References of these studies were analyzed yielding three more trials. The seven results were evaluated by comparing the intervention used to improve adherence, how adherence was assessed, and the outcome of the intervention tested. Different approaches to increase adherence such as written eczema action plans, educational workshops, extra office visits, and use of an atopic dermatitis educator were evaluated. All interventions increased adherence rates or decreased severity in patients, except for two. The MEDLINE search yielded limited results due to a lack of studies conducted specifically for atopic dermatitis and adherence was measured using different methods making the studies difficult to compare. Interventions including patient education, eczema action plans, and a quick return for a follow-up visit improve adherence, but based on the lack of clinical trials, developing new techniques to improve adherence could be as valuable as developing new treatments.
Highlights
Atopic dermatitis, like other chronic diseases, requires treatment over an extended period of time making management difficult
The study completed by Rork et al used a written eczema action plan (EAP) giving instructions on daily skin care routine and when and where to apply topical steroids, similar to those used in asthma patients
At follow-up, 80% of the parents rated their child’s eczema lower on the severity scale, their treatment comfort level increased from 57% to 86%, and 86% found the EAP helpful
Summary
Like other chronic diseases, requires treatment over an extended period of time making management difficult. Adherence to treatment of chronic diseases with topical medications is poor. Even if patients with atopic dermatitis do fill the prescription, adherence may still be poor, with a mean adherence rate of only 40% for five days and 32% for eight weeks [4,5]. Non-adherence may be related to forgetfulness, the time consuming nature of topical treatment, financial burden, lack of a trusting physician-patient relationship, dislike of the prescribed vehicle, steroid phobia or other fears, or a lack of understanding about the disease and proper application of medication [6]. Some 1 to 3.8 billion dollars per year are spent in the United States for treatment of atopic dermatitis; if patients were more adherent, unnecessary return visits and medication changes could be avoided, and healthcare dollars could be saved [7,8]
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