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Stealth monitoring of adherence to topical medication: Adherence is very poor in children with atopic dermatitis

https://doi.org/10.1016/j.jaad.2006.05.073Get rights and content

Background

Atopic dermatitis is a common problem for which topical agents are the primary treatment. When topical medications fail, further therapy may include systemic agents with the potential for greater toxicity. Adherence to topical treatment of atopic dermatitis has not been well characterized. Poor adherence to topical medication could account for failure of topical therapy.

Purpose

To determine adherence to topical treatment in patients with atopic dermatitis.

Methods

Thirty-seven children were given 0.1% triamcinolone ointment and were counseled to use it twice daily. They were told to return in 4 weeks, at which time they were told to continue treatment for another 4 weeks. Electronic monitors were used to measure adherence over the entire 8 week study. Patients were not informed of the compliance monitoring until the end of the study.

Results

Twenty-six patients completed 8 weeks of treatment. Mean adherence from the baseline to the end of the study was 32%. Adherence was higher on or near office visit days and subsequently decreased rapidly.

Limitations

This study was limited by the large number of subjects who failed to return for follow-up appointments or withdrew from the study.

Conclusions

Adherence to topical medications is very poor in a clinic population of children with atopic dermatitis. Office visits are one means to increase adherence. If adherence to topical treatment can be improved, exposure to more costly and potentially toxic systemic agents may be avoidable.

Section snippets

Methods

We enrolled 37 patients from the Dermatology Clinic at the Wake Forest University School of Medicine. There were no advertisements for this study. Eligibility criteria included age of 12 years or younger and diagnosis of mild to moderate atopic dermatitis (suitable for treatment with triamcinolone ointment) by a dermatologist. Patients and their parents were told we wanted to see how well a commonly used corticosteroid ointment works for their atopic dermatitis; verbal consent was obtained.

Results

Twenty-six children with mild to moderate atopic dermatitis completed the study. More than half the sample consisted of male children (54%) and had black ethnicity (62%). Mean age was 4.4 years with a range from 6 months to 14 years. One subject was enrolled in the study who was 14 years old. It was later realized by the study staff that the cutoff age was 12 years. The subject was left in the study and completed the 8-week course. The EASI score at baseline was 10.1 (out of a possible score of

Discussion

Adherence to topical medication is poor in study settings. An Italian study using self-reported adherence found adherence rates of only 50% in psoriasis patients.11 Mean overall adherence to topical therapy in psoriasis over 8 weeks was 55% when assessed with electronic monitors, far lower than the 90% to 100% adherence rates reported by patient diaries and medication weight estimates.9

We anticipated that adherence in a typical patient population would likely be lower than adherence in clinical

References (11)

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Funding sources: None.

Disclosure: The Center for Dermatology Research is supported by an educational grant from Galderma Laboratories, L.P. The authors have no conflicts of interest to disclose.

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