Survey Reveals 76% of Patients with Psoriasis Prefer Topical Treatments

April Armstrong, MD, MPH

Credit: UCLA Health

According to an online survey of patients with psoriasis living in the United States, most patients (76%) prefer a topical treatment rather than pills or injections and most (89%) are willing to try a new topical treatment.

Despite topical treatments being the foundation for patients with psoriasis, and an increasing number of treatment options available, adherence to medications may be impacted by treatment burden and the preferences of patients. A recent study of 93 patients with psoriasis showed self-reported adherence rates were only 50%. Decreased adherence was demonstrated among those with a family history of psoriasis, those with severe disease and those with lower extremity involvement.

“Understanding patient preferences regarding topical medications could improve satisfaction and adherence to therapies, leading to improved outcomes from the use of topical medication,” wrote lead investigator April Armstrong, MD, MPH, professor and chief of dermatology at University of California Los Angeles (UCLA).

The Harris Poll conducted a short, 15-minute survey between October and November 2021 to better understand preferences medication delivery method—such as topical, oral, and injectables—treatment pattern, patient satisfaction and perspectives on topical therapies. Eligible patients were aged ≥ 18 years, had a prescription to a topical treatment at the time of the survey and were not receiving injectable treatment for their condition. Demographic information, including age, race/ethnicity, education, household size, census region and marital status, was collected.

Among the 507 participants who were currently prescribed a topical treatment, most patients described their symptoms as moderate (59%) or mild (31%). Most patients reported being treated by a dermatologist (76%) followed by a primary care physician (45%).

The average body surface area affected by psoriasis was 14.6%. The most commonly affected areas of the body included the arms, knees, legs, elbows, scalp and intertriginous areas. The areas that caused the greatest impact on quality of life were the scalp (39%), elbows (20%) and legs (excluding the knees; 19%).

Regarding treatment options, 76% preferred topical therapies, 20% preferred pills and 4% preferred injections to treat their psoriasis. However, one out of four patients reported being somewhat or very dissatisfied with the topical treatments they were prescribed. Compared with those who were satisfied with their topical treatments, these patients were also more likely to have more severe symptoms at diagnosis (18% vs 7%, respectively), want options for once-daily dosing (63% vs 27%, respectively) and prefer injection treatments (9% vs 2%, respectively). Reasons they were unsatisfied with medication delivery included inefficacy (67%), having to reapply the treatment multiple times per day (53%) and describing the creams as messy or greasy (38%).

Common product attributes patients sought in a topical treatment were itch relief (68%), improvement in plaques (68%) and ease of application (63%). Nearly all (89%) were interested in trying a new topical treatment for their psoriasis, 87% said they wanted a once-daily application and 81% wanted more topical treatment alternatives to steroids.

Investigators noted only including patients receiving topical therapies as a limitation of the study, as it excluded many patients with mild-to-moderate psoriasis who were not using any therapy or those who were using topical treatments in combination with an injectable therapy. Therefore, this could have culminated in a biased treatment preference of topical therapies compared with other treatment methods.

“Offering patients treatment options that address these key factors impacting patient satisfaction could enhance treatment adherence and, therefore, lead to improved topical efficacy,” investigators concluded. “This emphasizes the need for healthcare providers to consider patient preferences when prescribing treatments, as this could significantly impact treatment outcomes.”