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A Systematic Review of Factors Influencing Adult Adherence to Topical Medications in Atopic Dermatitis
Stacey N Giuffre1, Aditya Joshi2,3, Camila R Marquez2,4
1Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
Background:
Atopic dermatitis (AD) is a chronic inflammatory dermatosis requiring multifaceted treatment. Poor adherence to topical therapy hinders symptom management, highlighting the need to identify barriers influencing adherence among adults with AD.
Objective:
Identify factors influencing adherence to topical therapy among adults with AD and outline strategies to improve adherence.
Methods:
We conducted a systematic review following PRISMA guidelines and with PROSPERO registration (CRD42023488557). PubMed and EMBASE were searched in December 2023 for articles with relevant terms published from 2000 to 2023, and the search was updated in April 2025. Eligible studies reported original data on adherence to topical therapy in adults with AD and findings were categorized using the World Health Organization's adherence dimensions.
Results:
A total of 50 studies involving 17,124 adults across 17 countries were analyzed. Patient-related barriers included patient forgetfulness, knowledge about AD and treatment options, as well as topical corticosteroid phobia. Therapy-related factors included regimen complexity, vehicle preparation, and symptom perception. Cost and advice from family, friends, and the internet were frequent socioeconomic concerns. Healthcare system factors included clinician communication, time constraints, and inconsistent guidance. Condition-related factors including disease severity and chronicity also shaped adherence.
Conclusions:
Topical therapy adherence among adults with AD is influenced by several modifiable barriers including patient forgetfulness, education, treatment duration, and vehicle preparation. Future work should standardize adherence measurement tools and definitions. Proposed strategies may integrate patient-centered education, simplified regimens, reminder tools, cost reduction, and strong therapeutic relationships to support sustained adherence and improve long-term outcomes.
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