Good patient adherence to recommended plaque psoriasis therapies is a key component of attaining satisfactory disease control and improved quality of life. Multiple real-life factors can affect patient adherence to treatment, and addressing these factors is critical for optimal care.

In dermatology, we often combine therapies and will sometimes opt to use both topical and systemic options for patients with psoriasis, with the topical therapy being used as a breakthrough treatment when the patient is overall controlled with a systemic agent. When it comes to optimizing patient adherence to topical treatments, we need to consider the vehicle first and the active ingredient second. We are very lucky to have many vehicle options, including solutions, lotions, cream ointments, foams, oils, and gels. When selecting a vehicle, it is important to take patient preferences into consideration. This could be influenced by the body site(s) involved, the type of clothing the patient wears, the dosing frequency, the patient’s work setting, and the time of day that the treatment is applied, among other factors.

Once we have a sense of what the patient is willing to use topically, we can consider our active ingredient options. We have a growing body of steroid-free, anti-inflammatory agents that are well studied and can help address common patient concerns regarding starting treatment with a steroid. That said, I feel that it is important to highlight that steroids are relatively safe when used correctly, although the steroid-free options allow for a little more flexibility in their use without significantly sacrificing efficacy. So, we have the ability to tailor not only the vehicle to the patient’s preferences but also the active ingredient.

Dosing frequency is a very important adherence-related factor for both topical and systemic treatments. The less the patient has to do, the better. Although aspects of a patient’s psoriasis may change over time, this is a chronic disease that needs a chronic management strategy. The great news is that we have so many treatment options for our patients. For example, from an adherence standpoint, the once-daily dosing of the oral TYK2 inhibitor may represent a benefit over the twice-daily dosing of the oral PDE4 inhibitor.

The most important things in setting a patient up for success are setting realistic expectations regarding treatment outcomes and having an open-ended discussion on expected/desired outcomes. When should a patient with psoriasis expect to see change? When I ask a patient to come back in 4 to 6 weeks, I should clarify that I do not expect their skin to be clear at that point. Rather, I want to check in and make sure that they are doing okay on the treatment. Now, at what point will we assess for success, and when are we going to make treatment changes, if necessary? All of these conversations should happen during the patient’s first visit to set a trajectory for long-term success.