Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring.

BACKGROUND: Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short-term adherence. Psoriasis is a chronic disease, and long-term adherence is an even bigger problem. OBJECTIVES: To determine how well medication is used in the long-term topical treatment of psoriasis and to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes. METHODS: An investigator-blinded, prospective study evaluated topical fluocinonide adherence in 40 patients with mild-to-moderate psoriasis over 12 months. Subjects were randomized in a 1 : 1 ratio to standard-of-care or internet-based reporting group. Adherence was objectively monitored with Medication Event Monitoring System® caps. RESULTS: Fifty per cent of subjects discontinued the treatment. Greater adherence was seen in the intervention group compared with the standard-of-care group (50% vs. 35%, P = 0·08). Psoriasis Area and Severity Index improved more in the intervention group at month 1 (1·61 vs. -0·12, P = 0·003), month 3 (2·50 vs. 0·79, P = 0·025) and month 12 (3·32 vs. 0·34, P = 0·038) than in the standard-of-care group. CONCLUSIONS: This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes.

Entrance and propagation pattern of high-frequency electrical currents in biological tissues as applied to fractional skin rejuvenation using penetrating electrodes.

BACKGROUND: Fractional resurfacing of the skin using radiofrequency devices has been used for collagen remodeling and rejuvenation. OBJECTIVES: To determine how radiofrequency current enters and propagates through tissue, and the pattern of the resulting effect. MATERIALS AND METHODS: An electrosurgical device with a 0.4 MHz frequency output was used as the source of radiofrequency current. Current was applied via a metallic needle introduced into a large piece of cow liver, with different amounts of energy delivered at multiple points. Cross-sections of the liver were then studied for tissue effect. RESULTS: Thermal coagulation of tissue started from the tip of the electrode. With higher energy, a rim of coagulated tissue formed around the entire length of the needle. This rim of coagulated tissue was thicker around the tip of the electrode. CONCLUSION: Radiofrequency currents have a tendency to move toward the center of the bulk of tissue. When an electrode of a fractional radiofrequency device enters the skin, maximum heating effect will be around the tip of the electrode in the dermis. This phenomenon can preserve epidermis from injury during dermal heating, reducing post-procedural skin surface side effects seen with many skin rejuvenation procedures.