Objective assessment of compliance with psoriasis treatment

Objective: To assess patient compliance with psoriasis treatment. Design: Open prospective study. Patients with psoriasis were examined and completed a brief medical and social history, a compliance assessment sheet, and the Dermatology Life Quality Index (DLQI). Patients were reexamined at 3 months, and their actual treatment use was assessed and compared with the expected use. Medication adherence was assessed by direct questioning. Setting: Dermatology outpatient clinic. Patients: Two hundred ninety-four patients fulfilled the inclusion criteria, and 201 completed the study. Main Outcome Measure: Adherence with topical and oral therapies, using objective and self-reporting methods and description of factors affecting compliance. Results: The overall mean +/- SD medication adherence was 60.6% +/- 33.0% (range, 0%-169%). The mean +/- SD DLQI in the study was 17.4 +/- 8.9 (range, 0-30). There was a highly significant negative correlation (r=-0.92) between these variables. Being female, married, employed, and not paying for prescriptions were characteristics associated with increased medication adherence and a lower DLQI. Medication adherence was greater for topical or combined therapy, for once-daily treatment, and for first-time use of treatment. Adverse effects reduced compliance. The major reasons for missing treatment were drinking alcohol, being fed up, forgetfulness, and being too busy. Patients with facial disease and with more extensive disease had lower medication adherence. Conclusions: A range of disease-related and social factors may affect compliance with psoriasis treatment. The inversely proportional relationship between DLQI and medication adherence reflects the interaction of physical and psychological factors, as well as perceived treatment failure.