Treatment adherence in acne vulgaris: systematic review and narrative synthesis

Santer, Miriam, Maund, Emma, Becque, Taeko, Essery, Rosie, Barbieri, John S. and Thompson, Andrew R. ORCID: https://orcid.org/0000-0001-6788-7222 2026. Treatment adherence in acne vulgaris: systematic review and narrative synthesis. Skin Health and Disease , vzag084. 10.1093/skinhd/vzag084

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Abstract

Background Acne vulgaris is common and has a substantial impact on patients’ quality of life. Low adherence to acne treatments is a barrier to successful management. Objectives To examine the prevalence of adherence to oral and topical treatments for acne, factors associated with adherence and reasons for nonadherence. Methods We included primary quantitative studies that investigated acne-related experiences and behaviours, including predictors, determinants and outcomes associated with treatment adherence. We searched the following databases from inception until 24 March 2025, with no language restrictions: MEDLINE, PubMed, Embase, PsycINFO and CINAHL. Quality was appraised using the Mixed Methods Appraisal Tool. We present the findings related to observational studies, analysed using narrative synthesis. Results Twenty-six eligible papers reported studies in the Americas, Europe and Asia. Thirteen papers reported quantitative descriptive studies (8111 survey participants plus 2 studies that reported data from electronic health records) and 13 papers (12 studies, 37 884 participants) reported other designs such as analytic cross-sectional or cohort studies. Methods for evaluating adherence varied: 21 studies used self-report with differing questionnaire designs, 3 used prescription data to evaluate medication possession ratio, 3 assessed drug refills, 1 carried out database drug survival analysis and 1 used pill count or tube weighing. Four studies used more than one method. The prevalence of adherence estimates varied from 6% to 84%, with larger studies estimating 50–65% adherence. Adherence was lower among younger people, but there was inconsistent evidence for differences between men and women, or between topical and oral treatments. Reasons for nonadherence included cost, side effects, perceived treatment ineffectiveness or symptom resolution. Conclusions Improving treatment adherence in acne remains a priority, particularly for younger people. Interventions addressing the management of side effects and time to effectiveness of treatments may be beneficial.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology
Publisher:	Oxford University Press
Date of First Compliant Deposit:	10 August 2026
Date of Acceptance:	20 April 2026
Last Modified:	10 Aug 2026 14:00
URI:	https://orca.cardiff.ac.uk/id/eprint/188836

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