Patient compliance and disease management in the treatment of psoriasis inthe Netherlands

Background: Compliance behaviour and disease management are important issue s in chronic skin diseases. Psoriasis patients are 'experts by experience' because of ma ny yea rs of treatment. Therefore, it is re I eva nt to gathe r data from patients on the actual use of antipsoriatic treatments. Objecti ve: The following questions are addressed: (1) What is the present mode of prescription and actual use of antipsoriatic treatments, including topical treatments, photo(chemo)therapy and systemic treatments? (2) What informati on do patients expect from their doctor, and do they actually receive this information. Methods: To answer these questions, a questionnaire survey was mailed to the subscribers of Psoriasis, the journal of the Dutch Psoriasis Patients' Organisation. Results: (1) Major issues in the treatment of psor iasis are (a) long-term management, (b) control of mild, moderate but also extensive psoriasis and (c) control of psoriasis on difficult localisations . Patients perceive itch, scaliness and visibility as major criteria for ef ficacy. (2) Topical treatment is the mainstay in the management of psoriasi s. Calcipotriol is the most prescribed drug. Photo(chemo)therapy has an int ermediate position between topical and systemic treatments. UVB is prescrib ed more th an twice as frequently as PUVA a nd 10% of the patients on photo (chemo)therapy proved to be treated with UVB at home. Only 16% of the patie nts were on a systemic treatment; methotrexate and acitretin were the most frequently used systemic treatments. (3) More than 70% of the patients indi cated that they had taken part in the selection of a treatment. In general, the patients were satisfied about the contact with their dermatologist and general practitioner. Compliance with the duration of treatment is limited , especially with regard to topical treatment. Patient compliance with the dose of the treatment is better. Again compliance is the worst in topical t reatments. (4) Patients have a strong preference for an effective treatment which is safe for long-term use. Only a minority of patients wants a fast clearing treatment. Conclusion: Itch, scaliness and visibility provide the most relevant information on the severity of psoriasis, as the patients per ceive themselves. Treatment duration is often unrestricted, especially with regard to topical treatments, which implies that the cumulative toxicity p otential of these treatments may have a serious impact on their safety prof ile. Patients regard it of importance to have a vote in the selection of th e treatment and regard safety as more important than fast clearing. Copyrig ht (C) 2000 S. Karger AG, Basel.