Assessing Attributes of Topical Vehicles for the Treatment of Acne, Atopic Dermatitis, and Plaque Psoriasis

The skin care market includes topical product formulations (eg, foams, lotions, ointments, creams) for a number of dermatologic therapeutic targets; however, there is limited information available regarding patient preference for product vehicles by specific dermatologic disease. There are few studies in the literature examining patient adherence to topical medications.¹ In the current study, 6 focus groups comprised of patients with 3 dermatologic conditions of interest—acne, atopic dermatitis (AD), or plaque psoriasis (PP)—were surveyed to gain a better understanding of treatment preferences among patients and attributes of various formulations that are most desirable and important to this patient population.

Patient preference for a vehicle is relevant to treatment adherence in patients with conditions such as acne, AD, and PP because noncompliance is a major factor in the high rates of failure that have been associated with topical dermatologic treatments.² The aesthetic attributes of a given vehicle formulation depend on the disease state being treated, the site of application, and the length of treatment.³ A limited number of studies have linked patient preferences to the attributes of topical medications. In one study, participants preferred an aqueous gel formulation compared with previously used topical treatments for AD.³ In another study, participants ranked the following properties of a hypothetical topical medication as most important: gel formulation, room temperature storage, product life of up to 18 months once opened, application with fingers, and a once-daily regimen.² A third study found that foams were preferred among other formulations (ie, creams, gels, and ointments) for a variety of disease states, including AD, PP, and seborrheic dermatitis.⁴ The current study uses a qualitative analysis to further explore patient preferences of vehicle attributes for the topical treatment of acne, AD, and PP.

Methods

Study Participants

Six focus groups were conducted with patients who were using topical prescription medications for the treatment of acne, AD, or PP from March to April 2012. Participants were recruited from Raleigh, North Carolina, and New York, New York, with 3 focus groups (1 for each condition) from each city.

Following institutional review board approval of the study processes and recruitment materials, participants meeting the following criteria were included in the study: 18 years or older; diagnosed with acne, AD, or PP by a physician (participants who currently reported more than 1 of these conditions were not eligible); diagnosed with the respective skin condition at least 6 months prior to screening; current or prior use of topical prescription medications in at least 2 different vehicle formulations (eg, cream and foam, ointment and gel); use of at least 1 topical prescription treatment 5 or more times per month; and English speaking and able to provide written consent.

Study Design

A semistructured discussion guide was developed to ensure consistency in the topics surveyed among all 6 focus groups, and the same 2 moderators conducted the discussion for all 6 groups. At the beginning of the study, after providing written informed consent, participants were given an overview of the study and were asked general questions intended to get the participants talking about their experiences with their respective conditions. To avoid or minimize bias, participants were only asked open-ended questions designed to ascertain what symptoms they experienced in relation to their respective conditions. Finally, the discussions were focused on the topical prescription treatments that participants had tried and the properties of each treatment they liked and disliked.

The focus groups were recorded (audio) and transcribed; transcriptions were then verified through an iterative process of technical and editorial review. Analysis of the results was conducted by evaluation and review of the field notes as well as the transcripts from the focus groups.

Results

A total of 54 participants were surveyed (average age, 40.9 years). Although the average age of participants in the acne and AD groups was generally the same (35.2 and 35.4 years, respectively), the average age of participants in the PP group was higher (52.2 years). The majority of participants were white females who had at least a college degree. On average, participants had been diagnosed with their respective condition approximately 15.5 years prior to screening. Participant demographics and clinical characteristics are presented in more detail in Table 1.

At the time of screening, participants reported prior or present use of topical prescription medications in various formulations for treatment of their respective conditions. The most commonly reported vehicles across all 3 conditions were creams and ointments, followed by lotions, gels, and foams.