Physician Communication Linked to Improved Patient-Reported Outcomes in Actinic Keratosis

Solar keratoses on the scalp
Solar keratoses on the scalp
Overall, 961 participants had received a prescription for ingenol mebutate; 175 received either diclofenac 3% in hyaluronic acid or imiquimod 5%.

Clear communication between clinicians and patients with actinic keratosis (AK) is associated with greater treatment satisfaction and reduced risk for treatment nonadherence, according to study results published in the Journal of the European Academy of Dermatology and Venereology.

The researchers sought to evaluate the interplay between patient-physician communication, local skin reaction intensity, and lesion clearance rates (effectiveness parameter) on treatment satisfaction, quality of life, and treatment adherence in patients with multiple AKs receiving topical field-directed therapy.

A total of 1136 adult patients with discrete, clinically detectable, visible, multiple (ie, ≥3 lesions in a 25 cm2 area), grade I/II AKs who were prescribed treatment with a topical field-directed therapy were enrolled in the study. The investigators matched self-reported data with medical information that was recorded by dermatologists, using standard clinical forms. All participants were followed up at 2 separate points (T1: 8 days; T2: 25-30 days).

The majority of patients were elderly (>70 years of age) married men with poor socioeconomic status who had multiple lesions on their scalp or face. Overall, 961 participants had received a prescription for ingenol mebutate, and 175 received either diclofenac 3% in hyaluronic acid or imiquimod 5%.

The clearance rate reported at 1 month was 84%. Most of the patients (73%) reported feeling very supported and rated their dermatologist’s explanations as being very clear (54%). Treatment satisfaction, based on effectiveness and convenience scales, increased significantly during follow-up, particularly for those receiving ingenol mebutate (interaction P <.001). Communication clarity was linked to significantly higher treatment satisfaction scores (P <.01) and a lower risk for nonadherence among ingenol mebutate-treated patients (P <.01).

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The investigators concluded that communication clarity was associated with patient-reported outcomes and adherence beyond AK-related parameters. They question the current episodic approach to the management of patients with AK and provide the rationale for development of chronic care models that will help foster patients’ engagement and treatment alliance.


Neri L, Peris K, Longo C, et al; Actinic Keratosis – TReatment Adherence INitiative

(AK-TRAIN) study group. Physician-patient communication and patient-reported outcomes in the actinic keratosis treatment adherence initiative (AK-TRAIN): a multicenter, prospective, real-life study of treatment satisfaction, quality of life and adherence to topical field-directed therapy for the treatment of actinic keratosis in Italy [published online June 19, 2018]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.15142