title: Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  Our purpose was to determine the relative importance of factors contributing to nonadherence in topical corticosteroid users with psoriasis.
  
  
  METHODS
  A survey was distributed to psoriasis patients visiting an outpatient clinic.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Brown
authors.forename: Wingfield E
authors.initials: WE
authors.lastname: Rehmus
authors.forename: Alexa B
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D000305:Adrenal Cortex Hormones