Acne, Eczema, and Psoriasis: Improving Treatment Adherence in Younger Patients

Announcer:
This is DermConsult on ReachMD. On this episode, we’ll hear from Dr. Nicholas Brownstone, who’s a chief dermatology resident at Temple University Hospital in Philadelphia, Pennsylvania. He’ll be discussing treatment adherence in adolescents and young adults with acne, psoriasis, and eczema.

Here’s Dr. Brownstone now.

Dr. Brownstone:
So sometimes it’s difficult to have adolescent or young patients adhere to acne regimens.  This is an issue that we face every day in our clinics.  A couple things I do to kind of help increase adherence is I explain the treatment process very clearly to the patient while the parents are in the room, so I say, “Mom or dad, please listen as well.” If mom and dad’s listening, the child or the adolescent will most likely listen as well and be more motivated to complete their treatment regimen if they know their mom and dad are listening as well. I also like to set realistic expectations. This is not going to be fixed in a couple of weeks. It’s not going to be fixed tomorrow, so you have to keep doing the treatments. And I let them know this may take a couple of months to see some results, and that lets the patients know what the reasonable timeline is. If they start doing their treatment and they’re not better in a couple of days and they stop, we want to totally make sure that’s not a reason. Visual aids are very good as well: showing them before or after pictures and letting them know that even mild acne can be scarring, so this is not something that we should take lightly. We should be invested in this regimen. Also simple things such as having them set reminders, journal their treatment, or put their acne treatments next to their toothbrush—everyone has to brush their teeth when they leave the house—will remind them to use their acne medications properly. 

Adherence among adolescents for taking medications is a big problem that we see a lot, and adolescents are busy. I mean, we’re all busy, and sometimes to them, acne is not that big of a deal, especially if they have mild acne and it’s not really bothering them. I remind all these patients that even mild acne can become scarring and irreversible down the road, and so it’s something that we should take seriously. There’s a couple of things we can do to help improve adherence help with forgetfulness. I suggest reminders through apps or alarms on the phone and journaling your treatments. I say, “When you come back, I want to see every day where you take your medication. Put a check mark in a journal book.” And I don’t care if they do it or not, but they’re going to be doing it more than someone who is not doing that. They may lie and say, “I took the medication every day.”  They’ll show you the journal. But at least them showing you the journal will remind them to make sure that they’re taking their medication.

Counseling about side effects is important as well—letting the patients know what they’re going to expect, so when it happens to them, they don’t totally stop their medication and say, “I can’t deal with this.” If they know what’s coming, they’ll have a much better experience, and be much more adherent to it if they kind of know what the side effects will be. And finally, figuring out what kind of products they like to use. Do they want a gel? Do they want a wash? Do they want to take a pill? Having that conversation with the patient and getting them something that they want to use is really important as well, and that will increase adherence in the long run. 

Announcer:
That was Dr. Nicholas Brownstone talking about strategies for improving treatment adherence in adolescents and young adults with skin conditions. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!