Lee Ivy A, Maibach Howard I
Department of Dermatology, School of Medicine, University of California, San Francisco, California 94143-0989, USA.
Am J Clin Dermatol. 2006;7(4):231-6. doi: 10.2165/00128071-200607040-00004.
The objective of this article was to review patient adherence to topical medications and its relationship to health outcomes in dermatologic disease. To this end, MEDLINE searches from January 1966 through June 2006 and EMBASE searches from January 1974 through June 2006 were conducted. Relevant human efficacy studies, including randomized controlled trials, observational studies, and case-control studies, were selected on the basis of the key words 'compliance,' 'adherence,' 'pharmionics,' 'topical,' 'medication,' or 'dermatology.' Studies were included and reviewed on the basis of their experimental design, controls, and statistical analysis. Analysis revealed that suboptimal adherence to topical medications is a common cause of minimal response or lack of response to drugs and is linked with poor dermatologic outcomes in diseases such as psoriasis, atopic dermatitis, and acne. It is concluded that non-adherence to topical medications is as common as non-adherence to oral medications, and its relationship to poor health outcomes is clear. Several barriers to topical medication adherence and predictors of non-adherence are similar to those for oral medications, while other barriers and predictors are unique to topical medications and the nature of dermatologic disease. Further studies of effective interventions to increase adherence are necessary to improve health outcomes in dermatology.
本文的目的是综述患者对局部用药的依从性及其与皮肤病健康结局的关系。为此，检索了1966年1月至2006年6月的MEDLINE数据库以及1974年1月至2006年6月的EMBASE数据库。根据关键词“依从性”“坚持”“药剂学”“局部的”“药物”或“皮肤病学”，筛选出相关的人体疗效研究，包括随机对照试验、观察性研究和病例对照研究。根据研究的实验设计、对照和统计分析对研究进行纳入和综述。分析表明，局部用药依从性欠佳是药物反应轻微或无反应的常见原因，且与银屑病、特应性皮炎和痤疮等疾病的不良皮肤病结局相关。得出的结论是，局部用药不依从与口服药不依从一样常见，且其与不良健康结局的关系明确。局部用药依从性的若干障碍和不依从的预测因素与口服药相似，而其他障碍和预测因素则是局部用药及皮肤病性质所特有的。有必要进一步研究提高依从性的有效干预措施，以改善皮肤病的健康结局。
