Could new combinations of treatments help those people with acne currently trying to follow prescription regimes involving more than one med?
Followed up by the researchers from the Wake Forest Baptist Medical Center, the patients were called to ask about "primary adherence" to treatments - that is, about whether they collected their pharmacy treatments in the first place, or used them at all when they did.
The questions were aside from whether the meds would be used as directed - the survey did not ask about what researchers call secondary adherence.
Overall, 27% answered that they had not filled a prescription - effectively leaving just over a quarter of acne treatments on the pharmacy shelf.
The finding surprised the Wake Forest Baptist, Winston-Salem, NC, researchers - they cite previous research that suggests this type of nonadherence to acne treatment runs at around 10%.
Primary adherence, however, had not been well-described by previous medical research, and the authors add: "Many other studies have focused on the adherence frequency and increased secondary adherence in patients with acne."
Other findings in the study were that:
- Being prescribed one treatment for acne held the best chance of the patient collecting or using it, giving the lowest failure rate of 9%
- Those who were prescribed two medications had the highest rate of primary nonadherence at 40%
- Treatment recommendations numbering three or more products resulted in a failure rate of 31%.
'Nonadherence is a pervasive problem in all of medicine'
The study did not gain statistical significance because of the numbers of people researched, but "nonadherence is a pervasive problem in all of medicine, particularly when treating chronic conditions such as acne," says Dr. Steven Feldman, professor of dermatology at Wake Forest Baptist and lead author of the study.
Prof. Feldman calls for new combination treatments:
"The study showed that patients are more inclined to follow the treatment regimen when only one medication is prescribed.
Multiple agents are typically required to address the multiple factors that cause acne, but simplifying treatment regimens by prescribing products that contain two or more active ingredients could prove effective in reducing nonadherence."
While the authors did not design their research to find out the reasons why patients fail to get their prescriptions, they did hear "unprompted explanations" from the participants in the study. Reasons for nonadherence mentioned during the phone surveys included:
- Acne is not caused by chocolate, nuts or greasy foods, poor hygiene or masturbation
- Cystic acne is the most severe form of acne
- Practical self-care tips are helpful in ensuring acne, including cystic acne, is not made worse.
- Having similar medication already on hand
- Not agreeing with the prescribed treatment
- Improvement in their skin condition.
In addition to the main survey question - "You were prescribed one or more treatments at your visit. Did you decide to fill any of those? If yes, which treatment did you fill?" - the researchers also asked about any other treatments obtained over-the-counter without the need for a prescription. A final question also asked: "Do you use any gentle cleansers? Antibacterial soaps? Benzoyl peroxide? Salicylic acid?"
The study compared rates of success, as reported by the respondents' medication fulfilments, against the different forms of treatment recommendation noted in the medical records. For prescription-only drugs, 130 electronic scripts were issued and eight of these were not purchased.
For paper scripts, fewer were issued - 15 - but a higher proportion of these treatments - five - were not bought. And for over-the-counter treatment recommendations noted in the dermatology department's records, 53 of these were issued with 11 not fulfilled.
In September 2014, researchers claimed to have found that a compound derived from red grapes and in red wine - resveratrol - may be an effective treatment for acne.
Also last September, came news that "friendly" bacteria may help treat acne and ulcers.