Multiple factors affect psoriasis treatment compliance

April 19, 2004

CHICAGO - Psychological, social, and disease-related issues may influence a patient's compliance with psoriasis treatment, according to an article in the April issue of The Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, psoriasis is a common, chronic skin disorder that produces significant illness and can significantly effect quality of life. There are many treatment options for psoriasis ranging from simple topical medication to oral therapy with potentially toxic drugs, but there is no cure. In most patients, the need for treatment is lifelong. "Psoriasis, like many other similar [skin disorders], tends to be more emotionally than physically debilitating for patients. The effect of psoriasis on a patient is multidimensional, including the physical, social, and psychological health of the person, and is based largely on the patient's view of his or her condition," the article states.

Sameh Said Zaghloul, M.B.B.C.H., D.D.Sc., M.Sc., M.D., of The General Infirmary at Leeds, England, and colleagues evaluated compliance with topical and oral therapies in patients with psoriasis and identified factors affecting compliance among 201 patients (average age 45 years; range, 20-65 years) with psoriasis.

Patients completed a brief medical and social history and answered questions about their treatment compliance and their quality of life as related to their psoriasis at the beginning of the study. Patients were reevaluated three months later, and their actual treatment use was compared with the expected use.

The researchers found that on average, medication compliance was 60.6 percent. Women had a significantly higher medication adherence rate (77.9 percent, n=112) than men (38.8 percent, n=89). For single people, adherence was 44.2 percent (n=104), for married persons it was 78.2 percent (n=97), for employed people, it was 68.9 percent (n=134), and for unemployed people, it was 43.9 percent (n=67). The average medication adherence for people who paid for their medication was 45.5 percent (n=102), and for those who did not pay, it was 76.2 percent (n=99).

Medication adherence was greater for topical or combined therapy, for once-daily treatment, and for first-time treatment. Patients with facial disease and with more extensive disease had lower medication adherence. The researchers also found that the major reasons for missing treatment were drinking alcohol, being fed up, forgetfulness, and being too busy.

"Because of the instinctive aversion to skin disease and because of the skin's function as a major organ of social and sexual communication, it is understandable that skin disease leads to psychological disturbance, particularly of well-being," write the authors. "In this study, patients with psoriasis showed variable effects of their disease on quality of life, which was related in part to the different sites and extent of involvement, with facial disease having a marked effect. It is likely that self-image is one of the bases for the association of skin and psychological disturbance and is reflected in the [quality of life measurements]."
-end-
(Arch Dermatol. 2004;139:408-414. Available post-embargo at archdermatol.com)

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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