title: Adherence to topical therapies in actinic keratosis: A literature review.
abstract: BACKGROUND
  Actinic keratosis (AK) is a common skin condition, for which topical therapies are frequently prescribed. This review summarises current understanding of patient adherence and persistence to topical AK treatment by identifying literature relating to measures of adherence and persistence and influencing factors.
  
  
  METHODS
  A multi-database literature search was conducted (2004-2015) using key search terms. Supplementary searches of pivotal clinical trials and reference lists of eligible papers were also conducted.
  
  
  RESULTS
  Non-adherence and non-persistence rates varied between real-world studies (10-63% and 23-31%, respectively), with combined non-adherence and non-persistence reported as high as 88%. Methods to calculate adherence and persistence differed between studies. Adherence and persistence were generally higher in clinical trials than clinical practice. Key contributing factors to non-adherence and non-persistence to AK treatment were identified as: treatment duration, severity and persistence of local skin responses and patient confusion over treatment regimens.
  
  
  CONCLUSIONS
  The review highlighted a significant evidence gap regarding adherence and persistence to topical AK therapies. Combined, non-adherence and non-persistence may be as high as 88% in clinical practice, highlighting the importance of incorporating contributing factors to patient non-adherence into treatment decisions.
authors.affiliation: a Department of Medicine (Dermatology) , The University of Melbourne, St Vincent's Hospital Melbourne and Skin & Cancer Foundation Inc. , Carlton , VIC , Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Foley
authors.affiliation: b Clinic for Dermatology, Venerology and Allergology , St. Josef-Hospital, Ruhr-Universität Bochum , Bochum , Germany.
authors.forename: Eggert
authors.initials: E
authors.lastname: Stockfleth
authors.affiliation: c Department of Dermatology , Catholic University of Rome , Rome , Italy.
authors.forename: Ketty
authors.initials: K
authors.lastname: Peris
authors.affiliation: d Hopital Saint-Louis , Paris , France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Basset-Seguin
authors.affiliation: e Skin Centre , Barts and The London NHS Trust , London , UK.
authors.forename: Rino
authors.initials: R
authors.lastname: Cerio
authors.affiliation: f Departamento de Dermatologia, Universidade de Sao Paulo , Sao Paulo , Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Antonio Sanches
authors.affiliation: g Instituto Valenciano de Oncologia , Valencia , Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Guillen
authors.affiliation: h Adelphi Values , Bollington , UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Farrington
authors.affiliation: i Department of Dermatology , Mount Sinai Hospital , New York , NY , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
mesh_terms: D000287:Administration, Topical; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D016903:Drug Monitoring
keywords: actinic keratosis; adherence; field therapy; persistence; squamous cell carcinoma in situ; topical treatment