Psoriasis in childhood: effective strategies to improve treatment adherence

Figures & data

Table 1 Barriers to treatment adherence in pediatric psoriasis

Patient factors

Co-morbid physical and/or mental health disorders

Disease-related social stigma

Poor coping skills in the context of chronic medical condition

Age-related and developmental stage-related limitations

Difficulty with transfer of treatment responsibility during adolescence

Caregiver/parent and family factors

Co-morbid physical and/or mental health disorders

Multiple caregivers/lack of primary caregiver

Family stress/chaotic home environment

Fear of medication side effects/safety (eg, corticosteroid phobia)

Negative family communication style and lack of problem-solving skills

Provider factors

Lack of provision of clear verbal and written treatment instructions

Failure to educate adequately on disease and expectations for management

Treatment factors

Poor tolerability of treatment (eg, topical medications too messy/greasy)

Treatment too time-consuming/not convenient/negative impact on lifestyle

Complicated treatment regimen

System factors

Financial and health care insurance instability

Lack of access to alternative treatments/new technologies (eg, sprays, telehealth)

Inadequate access to mental health providers and integrated care with behavioral health

Insufficient advocacy and lack of awareness of disease in other settings (eg, schools)

Noncollaborative provider–patient/family relationship

Table 2 Interventions to increase adherence in pediatric psoriasis patients

Educate family
Medical knowledge	Discuss severity, contributing factors, and clinical course of psoriasis
Treatment options	Discuss topical therapies, phototherapy, and systemic therapies Discuss efficacy, safety concerns, and potential side effects Establish expectations for improvement Define flare (consider use of photodocumentation)
Collaborate on treatment plan
Provide recommendations and agree on treatment plan
Assess and address barriers to adhering to treatment plan
Time constraints	Identify priorities or enhance time management
Financial resources	Involve social work; work with pharmacy or insurance company on financial assistance
Forgetfulness	Use technology (eg, smart phone alarms/texts); frequent follow-up
Treatment aversion	Problem-solve ways to cope/distract; involve psychologist
Mental health/family issues	Assess, normalize, and validate; involve psychologist
Assess confidence in adherence
If high, provide positive reinforcement
If low, revisit and problem-solve barriers
Develop written action plan
Define type of interventions (eg, general skin care, injections, phototherapy, topical/oral medications) and frequency
Define site-specific application for topical medications
Include treatment adjustments for “flares”
Follow-up assessments
Reassess adherence	Reassess at every follow-up evaluation Increase frequency of follow-up as needed (eg, with any change in treatment plan or if disease not well-controlled) Problem-solve barriers as needed