Brown Katherine K, Rehmus Wingfield E, Kimball Alexa B
Stanford University School of Medicine, Stanford, California 94305, USA.
J Am Acad Dermatol. 2006 Oct;55(4):607-13. doi: 10.1016/j.jaad.2005.12.021. Epub 2006 Jul 13.
Medication nonadherence is a significant problem in psoriasis. Although previous research has aimed to quantify the prevalence of nonadherence in topical medication users, patient motivations for intentional nonadherence are not fully understood.
Our purpose was to determine the relative importance of factors contributing to nonadherence in topical corticosteroid users with psoriasis.
A survey was distributed to psoriasis patients visiting an outpatient clinic.
Among the 53 persons surveyed, medication nonadherence was 40%. Frustration with medication efficacy, inconvenience, and fear of side effects were the most important reasons patients deviated from usage instructions. Subjects who did not receive instructions on topical treatment duration used corticosteroids longer (>8 weeks) than subjects who were instructed (P < .05).
A relatively small sample size prevented trends in demographic predictors of adherence from reaching statistical significance. The patient self-report format has the potential to introduce recall bias.
Factors contributing to intentional nonadherence, including dissatisfaction with efficacy, inconvenience, and fear of side effects, are the most important patient-identified barriers to appropriate use of topical steroids in psoriasis. Clear patient instructions on the intended steroid treatment duration may reduce adverse effects from overuse.
药物治疗依从性差是银屑病治疗中的一个重要问题。尽管先前的研究旨在量化局部用药患者中不依从的发生率，但患者故意不依从的动机尚未完全明确。
我们的目的是确定导致银屑病外用皮质类固醇使用者不依从的因素的相对重要性。
对前往门诊就诊的银屑病患者进行了一项调查。
在53名接受调查的患者中，药物治疗不依从率为40%。对药物疗效感到沮丧、不便以及对副作用的恐惧是患者偏离用药说明的最重要原因。未接受局部治疗持续时间指导的受试者使用皮质类固醇的时间（>8周）比接受指导的受试者更长（P<.05）。
样本量相对较小，使得依从性人口统计学预测因素的趋势未达到统计学显著性。患者自我报告的形式可能会引入回忆偏差。
导致故意不依从的因素，包括对疗效不满意、不便以及对副作用的恐惧，是患者确定的银屑病患者正确使用外用类固醇的最重要障碍。向患者明确说明类固醇的预期治疗持续时间可能会减少过度使用带来的不良反应。
