Medication Beliefs and Adherence to Topical Therapies for Atopic Dermatitis

A 2026 study by Tai et al, titled, “Do Medication Beliefs Influence Adherence to Topical Therapies in Patients With Atopic Dermatitis?” found that patients’ medication beliefs, sociodemographic characteristics, and health-related factors were significantly associated with adherence to topical treatment.1

Medical adherence in atopic dermatitis (AD) remains a significant barrier to successful treatment, with greater rates of nonadherence reported for topical therapies compared to oral and injectable medications.2 Improving adherence to topical treatment can improve patient outcomes, decrease treatment costs, and prevent unnecessary escalation to advanced therapies.3 Thus, understanding patients’ attitudes and beliefs toward medications may help clarify the rationale for adherence behaviors and identify avenues for clinical interventions.

In this cross-sectional study, researchers recruited adult AD patients from a tertiary-level dermatology ambulatory care center in Singapore between March 2024 and June 2024. A total of 386 participants completed the study (436 invited; 88.5% response rate) and self-reported their medication beliefs and adherence using the Beliefs about Medications Questionnaire (BMQ) and the five-item Medication Adherence Report Scale (MARS-5), respectively. Sociodemographic data (age, gender, education level) and health-related factors (use of reminder aids, perceived severity of disease) were also collected and analyzed. A total of four topical therapies were studied: topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), moisturizers, and topical anti-itch medications.

RESULTS

A significant difference in adherence was reported for all therapies (P<0.001). Although TCS and moisturizers were the most used therapies (n=336, 305, respectively), TCS had the lowest adherence (35.3% adherent) and moisturizers had the greatest adherence (56.7% adherent). Sociodemographic factors such as older age (≥ 60 years) were associated with greater adherence to TCS (P=0.014) and topical anti-itch medications (P=0.009), whereas higher education level was significantly correlated with greater nonadherence to anti-itch therapies (P=0.036). Health-risk factors such as greater perceived severity of AD (P=0.002) and the use of reminder tools for application (P=0.046) led to significant increases in moisturizer adherence. Perceived AD severity was also correlated with adherence to TCS (P=0.018) and anti-itch therapies (P=0.004). Analysis of BMQ scores revealed that higher adherence was correlated with higher perceived need for treatment, lower concerns about medication risks, and a positive necessity-concern differential, particularly for TCS and TCI.

CLINICAL IMPLICATIONS

In this cross-sectional study, higher perceived AD severity, use of reminder aids for treatment compliance, and greater perceived need for treatment were associated with increased adherence to topical therapies. In contrast, increased concerns about harmful side effects of treatment were associated with nonadherence, especially for therapies with commonly reported adverse effects such as TCS and TCI. These findings suggest that patient education addressing fears about treatment and promoting positive medication effects may improve adherence.

However, this study had several limitations that should be addressed before these findings can be applied to clinical practice. For example, participants were recruited by convenience sampling at a pharmacy store within the care center, limiting the generalizability of the findings. Furthermore, the use of self-reported questionnaires introduced potential bias as patients often overestimate adherence behaviors.³ Future studies should focus on tracking adherence behavior via medical records and exploring additional factors influencing the patient decision-making process such as topical vehicle preference, cost of medications, and dosing frequency.

“

These findings highlight keratinocyte lipid metabolism as a previously underrecognized target of bacterial virulence and underscore 
the importance of microbial signaling in 
chronic wound healing.

”