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Background@#In psoriasis treatment, not all body regions improve simultaneously after clinical interventions. @*Objective@#This study was aimed at evaluating clinical responses across body regions, which may differentially influence patient treatment plans. @*Methods@#This prospective, observational, and multi-center study was conducted in Koreans who adhered to ustekinumab treatment based on criteria per local label and reimbursement guidelines. A total of 581 were included in this analysis. @*Results@#The mean (±standard deviation) psoriasis area severity index (PASI) score at baseline, age, disease duration, and body surface area (%) were 18.9±9.69, 44.2±13.29 years, 11.3±9.65 years, and 27.8±17.83, respectively. Across the head and neck, upper extremities, trunk, and lower extremities, the correlation between the PASI sub-scores for the upper and lower extremities was the highest (r=0.680). The mean PASI sub-score for the lower extremities was the highest at baseline. PASI90 and PASI100 scores were the highest for the head and neck region, indicating the highest response rates, while those for the lower extremities were consistently low at all visits. @*Conclusion@#We found differences in regional ustekinumab responses, with the lower extremities being the most difficult to treat. These findings should be considered in psoriasis treatment.
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Background@#Although patients with psoriasis have an increased risk of cancers, little is known about the risk of psoriasis in cancer patients. @*Objective@#We aimed to comparatively analyze the incidence and risk factors of psoriasis in gastric cancer patients who underwent gastrectomy and in the general population. @*Methods@#A nationwide retrospective cohort of 52,608 gastric cancer survivors (2007~2015) was compared to 123,438 matched controls from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated the HRs for psoriasis according to adjuvant cancer treatment, obesity, and vitamin B12 supplementation in gastric cancer survivors. @*Results@#During a mean follow-up of 6.85 years, 645 of the 52,608 gastric cancer patients developed psoriasis, while 1,806 in the 123,438 matched control group developed psoriasis. Gastric cancer patients had a decreased risk of psoriasis (HR, 0.86; 95% confidence interval, 0.79~0.94), especially those who underwent subtotal gastrectomy. We found that vitamin B12 supplementation for more than 3 years had an additive effect on decreasing the risk of psoriasis in gastric cancer patients who underwent subtotal gastrectomy. Total gastrectomy, radio/chemotherapy, and obesity did not affect the risk of psoriasis in gastric cancer survivors. @*Conclusion@#The incidence of psoriasis is slightly lower in gastric cancer survivors than in the general population. Our results suggest that the development of psoriasis may be reduced by removing the source of systemic inflammation caused by Helicobacter pylori infection through subtotal gastrectomy in gastric cancer survivors.
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Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
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Background@#Cyclosporine (CsA), an immunosuppressant that specifically regulates T-lymphocytes, has long been used in dermatology practice. However, nephrotoxicity, a well-known adverse effect associated with high-dose (≥5 mg/kg/d) and long-term administration (≥2 years) has limited the use of CsA. @*Objective@#We investigated the association between the cumulative dose of CsA and renal dysfunction, as well as the long-term effects of low-dose CsA on renal function in patients who presented with dermatological conditions. @*Methods@#The study included 697 patients who received CsA at an outpatient dermatology clinic between January 2015 and May 2019. Logistic regression analysis was performed to determine the association between the cumulative dose of CsA and renal dysfunction. @*Results@#Compared with patients who received the lowest cumulative dose (˂7,000 mg), those who received the highest cumulative dose of CsA (≥30,600 mg) showed a 64% higher risk of renal dysfunction; however, the difference was not statistically significant (odds ratio 1.64, 95% confidence interval 0.39∼6.84). @*Conclusion@#Among patients who receive a low-dose CsA regimen, those who are treated with cumulative doses higher than the critical value may be predisposed to renal dysfunction, whereas those treated with a cumulative dose lower than the critical value are unlikely to develop nephrotoxicity.
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Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
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Background@#Cyclosporine (CsA), an immunosuppressant that specifically regulates T-lymphocytes, has long been used in dermatology practice. However, nephrotoxicity, a well-known adverse effect associated with high-dose (≥5 mg/kg/d) and long-term administration (≥2 years) has limited the use of CsA. @*Objective@#We investigated the association between the cumulative dose of CsA and renal dysfunction, as well as the long-term effects of low-dose CsA on renal function in patients who presented with dermatological conditions. @*Methods@#The study included 697 patients who received CsA at an outpatient dermatology clinic between January 2015 and May 2019. Logistic regression analysis was performed to determine the association between the cumulative dose of CsA and renal dysfunction. @*Results@#Compared with patients who received the lowest cumulative dose (˂7,000 mg), those who received the highest cumulative dose of CsA (≥30,600 mg) showed a 64% higher risk of renal dysfunction; however, the difference was not statistically significant (odds ratio 1.64, 95% confidence interval 0.39∼6.84). @*Conclusion@#Among patients who receive a low-dose CsA regimen, those who are treated with cumulative doses higher than the critical value may be predisposed to renal dysfunction, whereas those treated with a cumulative dose lower than the critical value are unlikely to develop nephrotoxicity.
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Purpose@#To describe the clinical characteristics and treatment outcomes of uveitis in patients with psoriasis in Korea. @*Methods@#The medical records of 20 patients (27 eyes) with psoriatic uveitis in two tertiary hospitals were retrospectively reviewed. We analyzed data about patient demographics, uveitis types, laterality, onset of disease, human leukocyte antigen (HLA) types, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis. @*Results@#The cohort comprised 11 males and nine females (age of onset, 50.1 ± 13.2 years) and the mean follow-up period was 3.9 ± 4.0 years. Types of uveitis included anterior (85%), intermediate (10%), and panuveitis (5%). A total of 13 (65%) cases presented with unilateral involvement and 12 out of 18 patients (66.7%) were positive for HLA-B27. The average intraocular pressure of affected eyes was 11.6 ± 3.6 at the first visit and 13.8 ± 3.6 mmHg at the final visit. The average logarithm of the minimum angle of resolution visual acuity of affected eyes at the initial examination was 0.16 ± 0.52 and 0.27 ± 0.71 at the last examination. Most common comorbidity (13 patients, 65%) was psoriatic arthritis (PsA). All cases underwent topical corticosteroid treatment; however, 11 (55%) required systemic corticosteroid and immunosuppressants for the treatment of uveitis. Notable deterioration in visual outcome was found in two cases (10%) due to severe intraocular inflammation and its complications (uveitic glaucoma and bullous keratopathy). Recurrent uveitis was observed in 57.9% of patients. Patients with PsA tended to have higher positive rate of HLA-B27 (83.3%). However, there was no significant correlation between visual prognosis and location of psoriatic uveitis, presence of PsA, and HLA-B27 positivity. @*Conclusions@#Psoriatic uveitis in Koreans usually presents with anterior uveitis with unilateral involvement. PsA was the most common comorbidity. In majority of patients, visual outcomes are satisfactory with appropriate topical or systemic immunosuppressive treatment.
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Background@#Nail psoriasis is a common clinically significant symptom of psoriasis. However, few studies have focused on the characteristics and course of toenail psoriasis. @*Objective@#To investigate the treatment response of toenail psoriasis during a 52-week period of ustekinumab use. @*Methods@#Patients were evaluated using the Nail Psoriasis Severity Index (NAPSI) at every injection visit. NAPSI score changes throughout the treatment were analyzed. The treatment response in each toenail and each NAPSI characteristic was also analyzed. @*Results@#A total of 22 patients with chronic plaque psoriasis with concomitant toenail psoriasis were examined. Several characteristics such as ridging or onychomycosis that mimic psoriasis or hinder the evaluation were identified. NAPSI significantly improved during the treatment (p＜0.05). The big and second toes were significantly improved after 52 weeks of ustekinumab treatment (p＜0.05). Pitting and oil-drop discoloration were the only two characteristics that showed significant changes post-treatment (p＜0.05). @*Conclusion@#Ustekinumab proved to be efficacious in treating toenail psoriasis.Because of the factors that hinder the NAPSI scoring, only NAPSI scores of the first and second toes can be used.
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Background@#The clinical features of inflammatory papulardermatoses of the face are very similar. Their clinical manifestationshave been described on the basis of a small numberof case reports and are not specific. @*Objective@#This studyaimed to use computer-aided image analysis (CAIA) to comparethe clinical features and parameters of inflammatorypapular dermatoses of the face and to develop a formalizeddiagnostic algorithm based on the significant findings. @*Methods@#The study included clinicopathologically confirmedinflammatory papular dermatoses of the face: 8 casesof eosinophilic pustular folliculitis (EPF), 13 of granulomatousperiorificial dermatitis-lupus miliaris disseminatusfaciei (GPD-LMDF) complex, 41 of granulomatous rosacea-papulopustular rosacea complex (GR-PPR) complex,and 4 of folliculitis. Clinical features were evaluated, andarea density of papular lesions was quantitatively measuredwith CAIA. Based on these variables, we developed a predictivemodel for differential diagnosis using classificationand regression tree analysis. @*Results@#The EPF group showedlesion asymmetry and annular clusters of papules in all cases.The GPD-LMDF complex group had significantly higher perioculardensity. The GR-PPR complex group showed a higherarea density of unilateral cheek papules and the highest total area density. According to the predictive model, 3 variableswere used for differential diagnosis of the 4 diseasegroups, and each group was diagnosed with a predictedprobability of 67%∼100%. @*Conclusion@#We statisticallyconfirmed the distinct clinical features of inflammatory papulardermatoses of the face and proposed a diagnostic algorithmfor clinical diagnosis.
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Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
ABSTRACT
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
ABSTRACT
Psoriasis is a chronic inflammatory disease. Medical therapy is the mainstay of the management of psoriasis, and the main target of psoriasis treatment is immunological dysregulation. Cyclosporine and methotrexate, the main conventional psoriasis treatments, usually lead to a Psoriasis Area and Severity Index (PASI) 75 response in 50% to 60% of patients, but show some organ toxicity. Biologics for psoriasis have recently become the main therapeutic agents for moderate to severe psoriasis unresponsive to conventional treatment. Tumor necrosis factor-α inhibitors were the first anti-psoriatic biologics to be developed, and also show good efficacy for psoriatic arthritis. Ustekinumab, the sole biologic designed for the inhibition of interleukin (IL)-12/23, has been most widely used for psoriasis in Korea. The main strength of ustekinumab is its relatively long treatment interval. IL-17 inhibitors have recently been introduced in Korea for psoriasis treatment. Secukinumab and ixekizumab are currently available IL-17 inhibitors that block the development of psoriasis lesions in the downstream events of psoriasis pathogenesis. They have excellent therapeutic efficacy, with a PASI 90 response in up to 60%–70% of patients. Selective IL-23 inhibitors have been more recently introduced in our country. They have an excellent PASI 90 response, and a longer injection interval than IL-17 inhibitors. New immunological modulators such as phosphodiesterase inhibitors, tyrosine kinase 2 inhibitors, and janus kinase inhibitors are planned to be introduced for psoriasis treatment. These are small molecules that can be administered orally, and some patients who are reluctant to receive injection therapy are expected to favor these therapeutic agents.
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BACKGROUND: Scalp psoriasis severely affects patients' quality of life, and patients may occasionally be refractory to topical steroid application. Although systemic therapy combined with topical steroid application is recommended for treatment-resistant scalp psoriasis, previous research has not reported whether such combination treatment improves patients' quality of life.OBJECTIVE: This study investigated whether combination therapy using oral cyclosporine and topical steroid reduces the severity of scalp psoriasis and improves patients' quality of life compared with the use of topical steroid alone.METHODS: The study included 23 patients with scalp psoriasis who were categorized as patients who received topical steroid therapy alone vs. those who received combination therapy with topical steroid and oral cyclosporine for 12 weeks. The severity of psoriasis and quality of life were evaluated at 4, 8, and 12 weeks of treatment.RESULTS: No significant improvement was observed in the severity of psoriasis or in patients' quality of life during the treatment period in patients receiving topical steroid alone. Patients treated with a combination of topical steroid and oral cyclosporine showed a reduction in the severity of psoriasis from the 4th week of treatment and their quality of life improved from the 12th week of treatment.CONCLUSION: Combination therapy with oral cyclosporine and topical steroid may reduce the severity of scalp psoriasis and improve patients' quality of life.
Subject(s)
Humans , Cyclosporine , Psoriasis , Quality of Life , ScalpABSTRACT
Psoriasis is a chronic inflammatory disease. Medical therapy is the mainstay of the management of psoriasis, and the main target of psoriasis treatment is immunological dysregulation. Cyclosporine and methotrexate, the main conventional psoriasis treatments, usually lead to a Psoriasis Area and Severity Index (PASI) 75 response in 50% to 60% of patients, but show some organ toxicity. Biologics for psoriasis have recently become the main therapeutic agents for moderate to severe psoriasis unresponsive to conventional treatment. Tumor necrosis factor-α inhibitors were the first anti-psoriatic biologics to be developed, and also show good efficacy for psoriatic arthritis. Ustekinumab, the sole biologic designed for the inhibition of interleukin (IL)-12/23, has been most widely used for psoriasis in Korea. The main strength of ustekinumab is its relatively long treatment interval. IL-17 inhibitors have recently been introduced in Korea for psoriasis treatment. Secukinumab and ixekizumab are currently available IL-17 inhibitors that block the development of psoriasis lesions in the downstream events of psoriasis pathogenesis. They have excellent therapeutic efficacy, with a PASI 90 response in up to 60%–70% of patients. Selective IL-23 inhibitors have been more recently introduced in our country. They have an excellent PASI 90 response, and a longer injection interval than IL-17 inhibitors. New immunological modulators such as phosphodiesterase inhibitors, tyrosine kinase 2 inhibitors, and janus kinase inhibitors are planned to be introduced for psoriasis treatment. These are small molecules that can be administered orally, and some patients who are reluctant to receive injection therapy are expected to favor these therapeutic agents.
Subject(s)
Humans , Arthritis, Psoriatic , Biological Products , Cyclosporine , Interleukin-17 , Interleukin-23 , Interleukins , Korea , Methotrexate , Necrosis , Phosphodiesterase Inhibitors , Phosphotransferases , Psoriasis , Severity of Illness Index , Tumor Necrosis Factor-alpha , TYK2 Kinase , UstekinumabABSTRACT
BACKGROUND: Drug survival, defined as the time until discontinuation, is a parameter reflecting real-world therapeutic effectiveness. Few studies have examined the influence of economic factors on the drug survival of biologic agents for psoriasis, particularly in Asian countries. OBJECTIVE: To determine the drug survival for ustekinumab in real-life settings and investigate the factors affecting drug survival for psoriasis patients in Korea. METHODS: We evaluated 98 psoriasis patients who were treated with ustekinumab at a single center. We analyzed the efficacy and drug survival of ustekinumab. Cox proportional hazard analysis and competing risk regression analysis were performed to reveal the factors affecting the drug survival of ustekinumab. RESULTS: The overall mean drug survival was 1,596 days (95% confidence interval [CI], 904~2,288). Among the 39 cessations of ustekinumab treatment, 9 (23.1%) patients discontinued treatment after experiencing satisfactory results. Multivariate Cox proportional hazard analysis revealed that paying on patients' own expense was the major predictor for the discontinuation of ustekinumab (hazard ratio [HR], 9.696; 95% CI, 4.088~22.998). Competing risk regression analysis modeling of discontinuation because of factors other than satisfaction of an event also revealed that ustekinumab treatment at the patient's expense (HR, 4.138; 95% CI, 1.684~10.168) was a predictor of discontinuation rather than satisfaction. CONCLUSION: The results of our study revealed that the cost of biologics treatment affects the drug survival of ustekinumab and suggested that economic factors affect the drug survival of ustekinumab treatment in Korea.
Subject(s)
Humans , Asian People , Biological Factors , Biological Products , Costs and Cost Analysis , Korea , Psoriasis , UstekinumabABSTRACT
BACKGROUND: Accurate assessment of the severity of psoriasis is important in daily practice and clinical studies. However, the assessment of psoriasis area and severity index (PASI) reflects the physician's experience, and thus evaluations by physicians are inherently subjective, with intra-rater and inter-rater variability. OBJECTIVE: To elucidate the effectiveness of PASI educational lectures and the use of reference photographs on the improvement of accuracy and reliability in PASI assessments and to develop effective educational programs for PASI assessments. METHODS: We performed a before-and-after comparison study during nation-wide PASI educational workshops. The participants were asked to assess the severity components of PASI (erythema, thickness, scale, and affected area) three times: in the test administered before an educational lecture, the test immediately after the lecture, and lastly the test with the use of reference photographs. The improvement of accuracy and reliability was analyzed by comparing the results of three tests. RESULTS: Ninety-six board-certified dermatologists and residents participated and 72 participants completed all three tests. The accuracy and reliability of the assessment of severity components of PASI increased significantly after the educational lecture and the use of reference photographs. Use of reference photographs resulted in limited improvements when the recognition of three-dimensional structures was required, such as in the assessment of thickness or scale. CONCLUSION: Our study confirmed that the combination of standardized educational training and reference photographs can improve the accuracy and reliability of PASI assessments. Understanding how to evaluate three-dimensional psoriatic lesions can help with proper assessment of the severity of psoriasis.
Subject(s)
Education , Lecture , Psoriasis , Severity of Illness IndexABSTRACT
BACKGROUND: No study to date has focused on the changes in laboratory test results and related risk factors in patients with psoriasis treated with prolonged Cyclosporine A (CsA) therapy. OBJECTIVE: The objective of this study was to investigate the changes of laboratory values and related risk factors in patients with psoriasis treated with CsA in a real-world setting. METHODS: Records of patients with psoriasis treated with CsA at an outpatient clinic were collected, and a Cox proportional hazards regression model was used. RESULTS: Of the 128 patients included in this study, 28 patients (21.9%) showed laboratory test abnormalities over a mean medication period of 11.6 months. Older age (hazard ratio [HR], 1.174; 95% confidence interval [CI], 1.068~1.370; p=0.007) and pre-existing kidney disease (HR, 0.008; 95% CI, 0~0.205; p=0.001) significantly increased the risk of renal dysfunction. Male sex was the only significant risk factor for liver enzyme elevation (HR, 0.284; 95% CI, 0.081~0.784; p=0.026) and uric acid abnormality (HR, 0.048; 95% CI, 0~0.372; p=0.046). CONCLUSION: This is an in-depth analysis of laboratory changes and related risk factors in patients with psoriasis treated with CsA. Liver is the most commonly affected organ of CsA toxicity. Older age, male sex, and presence of kidney disease were risk factors associated with laboratory abnormality during CsA treatment.
Subject(s)
Humans , Male , Ambulatory Care Facilities , Clinical Laboratory Techniques , Cyclosporine , Kidney Diseases , Liver , Psoriasis , Risk Factors , Uric AcidABSTRACT
BACKGROUND: The continuous use of biologic agents in the treatment of psoriasis has been reported to result in successful and sustained therapeutic effects and safety. However, some patients choose intermittent and repetitive treatment. OBJECTIVE: To determine the factors for selecting intermittent and repetitive ustekinumab treatment for the management of psoriasis. METHODS: From January 2011 to October 2016, we enrolled 30 psoriasis patients who discontinued ustekinumab treatment and were followed up for psoriasis treatment. We reviewed data regarding patients' clinical characteristics and the treatment they received, and investigated the factors for selecting intermittent treatment. RESULTS: A total of 52 ustekinumab treatment periods were administered to the 30 patients. Of the 52 treatment periods, 34.6% were covered by insurance and 82.4% were discontinued after sufficient improvement had been made or at the patient's request. Further analysis comparing the first and second ustekinumab treatments revealed that the patients who used ustekinumab in second treatment were more likely to be insured. In addition, the rate of patients reaching psoriasis area and severity index (PASI)75 and PASI90 was similar between the first and subsequent ustekinumab treatments. CONCLUSION: We found that the patients who used ustekinumab intermittently were those who were satisfied with the outcome of ustekinumab treatment but could not afford the treatment. These results suggested that economic burden can be a factor for the patients' choice of short-term intermittent treatment. The expansion of insurance coverage can increase the effectiveness of, and patients' satisfaction with, the management of psoriasis.
Subject(s)
Humans , Biological Factors , Cost of Illness , Drug Administration Schedule , Insurance , Insurance Coverage , Psoriasis , Therapeutic Uses , UstekinumabABSTRACT
BACKGROUND: There have been few studies of treatment adherence in Asian patients with psoriasis and understanding of the factors is important to improve outcomes. OBJECTIVE: To provide an overview of treatment adherence among Korean patients with psoriasis and to understand how the perceptions of patients and physicians affect topical treatment adherence. METHODS: A cross-sectional questionnaire survey was conducted to determine the views and opinions of dermatologists and psoriasis patients on topical treatment adherence. The survey items were developed in collaboration with psoriasis experts. RESULTS: Twenty-six dermatologists and fifty patients completed their questionnaire. In the physician survey, more than half of dermatologists only inquired about adherence up to 20% of the time. Most dermatologists generally thought that their patients had high expectations of treatment. Nearly 40% of dermatologists reported that more than 60% of their patients adhered to the prescribed topical treatment. In the patient survey, more than 15% of patients reported that they did not receive enough information about the drug. Around one-fifth of the patients also complained about the physical properties of the products. The majority of patients were confident with the current topical treatments and expected fast improvement, within a couple of weeks. The most common reason for low adherence was forgetfulness. Inconvenience and concerns about side effects were common reasons for topical treatment discontinuation. CONCLUSION: Because adherence to topical treatment is a complex, multifactorial issue with factors varying between patients, dermatologists should focus on determining each patient's individual adherence barriers to achieve good treatment outcomes.