title: Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized.
abstract: BACKGROUND
  Treatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE.
  
  
  METHODS
  A review of MEDLINE was performed using a combination of the phrases "adherence", "compliance", "lupus", and "cutaneous". Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included.
  
  
  RESULTS
  Only two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise.
  
  
  CONCLUSIONS
  Much of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.
authors.affiliation: Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA, mfarhang@wakehealth.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farhangian
authors.forename: William W
authors.initials: WW
authors.lastname: Huang
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman