Treatment adherence is an important variable in psoriasis therapy, and it can be the deciding factor between successful and unsuccessful outcomes. Prescribing once-a-day, cosmetically acceptable regimens can be key in achieving better treatment adherence in psoriasis patients.
Psoriasis can be difficult to treat, and it can be even more challenging should patients not adhere to the instructions given to them. Nonadherence to treatment not only leads to frustration for both patient and physician, but it may also result in protracted and seemingly ineffective treatment courses.
Psoriatic solutions, foams, sprays and medicated shampoos are much easier to comply with because they are not messy. However, patients often cite cosmetic reasons for not regularly using their prescribed topical therapies, particularly when prescribed greasy ointments, as these are notorious for staining clothes, sheets and furniture. Because ointments can be messy, the only practical time to apply them is in the evening.
"If an ointment applied twice a day is deemed the best therapeutic option, I often advise my patients to wear old pajamas before going to bed. In the morning, however, patients should first apply the ointment and then continue their daily morning routine, such as brushing their teeth, shaving, etc., and, just before dressing, they can wipe off the ointment. These 15 to 20 minutes of treatment can have a therapeutic impact on their psoriasis," Dr. Lebwohl says.
A once-a-day application of topical therapy is much easier to comply with than a twice-a-day regimen. Therefore, it would be advantageous to prescribe more potent medications once daily, whenever possible and indicated. According to Dr. Lebwohl, many of the medications that have been researched have been studied for once-a-day application, and for some of them, there is data that the once-a-day regimen is just as effective as twice a day. But this isn't always the case.
"Fluocinonide 0.1 percent cream (Vanos, Medicis) applied once a day for atopic dermatitis is just as effective if applied twice a day (Del Rosso J. Bhambri S. J Clin Aesthetic Dermatol. 2009;2(9):24–32). However, in psoriasis, a twice-a-day application with the same medication is more effective than once-a-day application," Dr. Lebwohl says.
Oral medications and biologics are less of an issue in terms of compliance, because physicians typically will take the extra time to educate their patients in great detail about these therapeutic modalities. According to Dr. Lebwohl, patients appear to be more compliant when given detailed instructions about a treatment.
"Because the drugs are systemic and because patients may need monitoring of some sort when taking such medications, we spend more time talking to patients about them, and, as a result, patients appear to take the therapy more seriously. I think patients are more compliant with systemic drugs than they are with creams and ointments, which can be messy," Dr. Lebwohl says.