Does Patient-Centric Design Hold the Key to Improving Adherence to Topical Dermatological Treatments?

🔍 Key Finding Topical medication adherence for skin diseases is low due to poor cosmetic acceptability, and patient-centric design, incorporating patient needs and preferences for vehicle properties like greasiness and ease of application, is crucial for maximizing adherence and treatment outcomes. This includes considering disease-specific needs based on lesion type and location, as well as patient-specific factors like motor impairment and age.

🔬 Methodology Overview

• Design: Narrative review
• Data Sources: Published literature, regulatory guidelines (EMA, FDA, ICH), pharmacopoeias (European, United States, Portuguese, British)
• Selection Criteria: Focus on patient-centric design of topical dermatological medicines, including vehicle properties, patient preferences, and target product profiles.
• Analysis Approach: Qualitative synthesis of information on topical vehicle characteristics, patient needs and preferences, and their relationship to dermatological conditions. Proposal of target product profiles based on this synthesis.
• Scope: Topical vehicles/bases in dermatology, patient-centric drug product design process, and development of target product profiles for common skin disorders.

📊 Results

• Topical treatment adherence rates are relatively low (50-70%), linked to poor cosmetic acceptability.
• Patient satisfaction is a key determinant of topical treatment adherence.
• Patient preferences vary based on skin disease, affected area, age, ethnicity, and gender.
• Younger patients (<40) prefer lotions, while older patients (>40) prefer creams.
• Females prefer creams, males prefer lotions and ointments.
• Black patients show a strong preference for ointments, while white patients prefer creams.
• Acne patients prefer washes, creams, and lotions, but after treatment experience, gels become highly preferred.
• Atopic dermatitis patients value hydration and low greasiness in emollients.
• Psoriasis patients prefer creams, ointments, and foams (especially for scalp), but dislike “messy” ointments. They value ease of application, quick absorption, and non-greasy/sticky/smelly formulations.
• 85% of psoriasis patients successfully transitioned from ointment/gel to aerosol foam, with improved adherence and quality of life.

💡 Clinical Impact This review emphasizes the importance of patient preferences in topical dermatological medication selection to improve adherence, proposing target product profiles for common skin diseases based on lesion type, location, symptoms, and patient needs. This information can guide clinicians in shared decision-making with patients, optimizing topical treatment selection and potentially improving clinical outcomes by enhancing adherence.

🤔 Limitations

• Few studies have addressed patient preferences regarding topical products.
• Limited number of vehicles compared in vehicle-preference studies.
• Small sample sizes in many vehicle-preference studies.
• Many studies compared only two vehicles or relied on patient perspectives rather than experiences.
• Inconsistent descriptions of dosage forms (e.g., “gel” could mean hydrogel or oleogel).
• Lack of preference ranking for attributes reported by patients with multiple skin conditions.
• Scarce information on patient preferences for seborrheic dermatitis and pigmentary disorders.

✨ What It Means For You Dermatologists should consider patient preferences, disease needs (lesion type and location), and patient-specific factors (e.g., motor impairment) when selecting topical vehicles/bases. Offering samples and discussing options can improve adherence and treatment outcomes. Compounding pharmacies can play a key role in personalizing topical medications when commercially available products don’t meet patient needs.

Reference Oliveira R, Almeida IF. Patient-Centric Design of Topical Dermatological Medicines. Pharmaceuticals. 2023;16:617. https://doi.org/10.3390/ph16040617