Why Some Patients Skip Their Acne Rx

Acne patients often skipped medications after seeking treatment

(RxWiki News) Why would patients want to skip their acne medications? Researchers are trying to find out.

A new study found that patients often failed to get both prescription and over-the-counter acne medications. And as more medications were prescribed, fewer patients were likely to get their medicine.

Although cost was sometimes a factor, patients listed a variety of reasons for not getting their acne medications. The authors of this study called for further research to improve patients' adherence to treatment.

Lead study author Steven R. Feldman, MD, PhD, a professor of dermatology at Wake Forest Baptist Medical Center in North Carolina, said in a press release, “Non-adherence is a pervasive problem in all of medicine, particularly when treating chronic conditions such as acne. A previous study reported a 10 percent primary non-adherence rate for acne patients, so we were surprised that what we found was more than twice that.”

Although acne is common in the teen years, it can also affect adults. Treatments range from over-the-counter products — especially for mild acne — to prescription products, antibiotics, laser treatments and chemical peels.

Dr. Feldman and team studied 43 patients who had seen dermatologists for acne. Recommended treatments included both prescriptions and over-the-counter products.

When more treatments were prescribed, patients were less likely to get one or more medications, Dr. Feldman and team found. Not getting or not using a medication is called primary non-adherence.

Altogether, 27 percent of patients in this study did not get all of their medications.

Patients who were prescribed two acne medications had a 40 percent rate of primary non-adherence. Those prescribed three or more medications had a 31 percent rate of primary non-adherence.

Patients who only received one prescription did much better. The primary non-adherence rate for this group was 9 percent.

Although Dr. Feldman and team were not specifically looking for reasons why patients did not get their medicines, the study patients listed some reasons. Among these were costs, forgetting to fill the prescription, having similar medication on hand already or disagreeing with the prescribed treatment. Some patients said the acne got better without medication.

Dr. Coyle S. Connolly, DO, a board-certified dermatologist and president of Connolly Dermatology, told dailyRx News that doctors can help increase patient medication adherence in several ways.

"Educate patients: Patients should have an understanding of the chronic nature of many skin conditions including acne," Dr. Connolly said. "In this way they will understand there may not be a quick fix and to expect ongoing treatment. Written and verbal instructions should be provided as friendly reminders to ensure compliance. Simplify treatments: Less is often better. Patients overwhelmed with several topical/oral products are more likely to be non-compliant with their medications. I will often start patients with a convenient twice daily regimen of topical and or oral medication. On subsequent visits, additional products may be added or ineffective products replaced as needed."

Doctors may also consider using combination products, Dr. Connolly said.

"Certain prescriptions combine 2 or more effective ingredients in one package," Dr. Connolly said. "This may lead to better compliance/results as there is only one application time versus two. With patients always on the go and ease of use a priority, combination products are a good idea."

This study was published March 20 in JAMA Dermatology.

The Center for Dermatology Research sponsored this study.

Some of the study authors received consulting or speaking fees from companies — such as Janssen, Eli Lily & Co., Amgen, Pfizer and GlaxoSmithKline — that make or distribute products used in acne treatment.

Review Date: 
March 19, 2015