[Adherence to treatment in chronic skin disorders]

Numerous studies report poor therapeutic adherence in chronic disorders, including chronic skin disorders. This article reviews compliance issues in a psychological perspective (mainly through the patient-physician relationship). Potential factors that could influence adherence to treatment related to the disease itself, the treatment, the patient, the physician and the patient-physician relationship are discussed. These different factors may be used to help the patient towards a better observance. Adherence to treatment is necessary in the long-term and has to be managed and reinforced all along. Listening is necessary from the beginning of the treatment in order to identify the specific demands of the patient, representations of the disease and its consequences on quality of life. The dermatologist has to detect and accept inescapable gaps in the follow-up of patients suffering from chronic disease, and try to understand them without discouraging. A genuine therapeutic alliance built through global care, is necessary to obtain adequate adherence to treatment.