Journal of the American Academy of Dermatology
Volume 59, Issue 4 , Pages 577-581, October 2008

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

  • Brad A. Yentzer, MD

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Christopher B. Yelverton, MD, MBA

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Daniel J. Pearce, MD

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Fabian T. Camacho, MS

      Affiliations

    • Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Zaineb Makhzoumi, BS

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Adele Clark, PA-C

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Ann Boles, RN, CCRC

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Alan B. Fleischer Jr., MD

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Rajesh Balkrishnan, PhD

      Affiliations

    • Ohio State University College of Pharmacy and School of Public Health, Columbus, Ohio
    • ,
  • Steven R. Feldman, MD, PhD

      Affiliations

    • Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • Corresponding Author InformationCorrespondence to: Steven R. Feldman, MD, PhD, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1071.

Accepted 3 June 2008. published online 11 July 2008.

Background

In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option.

Objective

We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis.

Methods

In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger.

Results

Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope −0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not.

Limitations

Small sample size and lack of follow-up on some patients were limitations of this study.

Conclusions

Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

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 Supported by National Biologic Corporation and Connetics.

 Disclosure: Dr Feldman has received research, speaking, and/or consulting support from Connetics, Roche, Amgen, Biogen, and Genentech. Drs Yentzer, Yelverton, Pearce, Fleischer, and Balkrishnan; Mr Camacho; Ms Makhzoumi; Ms Clark; and Ms Boles have no conflicts of interest to declare.

 Reprints not available from the authors.

PII: S0190-9622(08)00660-9

doi:10.1016/j.jaad.2008.06.007

Journal of the American Academy of Dermatology
Volume 59, Issue 4 , Pages 577-581, October 2008

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