{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T22:52:58Z","timestamp":1778626378718,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015621","name":"Applied Molecular Biosciences Unit","doi-asserted-by":"publisher","award":["UIDB\/04423\/2020"],"award-info":[{"award-number":["UIDB\/04423\/2020"]}],"id":[{"id":"10.13039\/501100015621","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006742","name":"CESPU","doi-asserted-by":"publisher","award":["POSOL-DERM-CESPU-2016"],"award-info":[{"award-number":["POSOL-DERM-CESPU-2016"]}],"id":[{"id":"10.13039\/501100006742","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>The influence of the vehicle in topical treatment adherence remains to be elucidated. The aim of this study is to analyze the influence of the pharmaceutical dosage form on adherence to topical treatment in psoriasis patients, taking into consideration the mechanical features. The adherence was evaluated in a sample of 102 psoriasis patients, followed for approximately 45 days. Adherence was calculated with a new combined methodology using a log and medication weights. The effect of the group formulation was evaluated using logistic regression models. A complex effect of the vehicle on adherence was found, mediated by the affected area. The adherence was significantly higher for patients applying gels and creams than for those using ointments, whenever the body area affected was extensive. The opposite was found when the affected area was small. Mechanical properties can partially explain the findings since gels and creams may be easier to apply. Patient beliefs and preferences regarding vehicles and their sensory attributes might also explain the results. It is noteworthy that adherence was strikingly low, with more than 75% non-adherent patients. This real-world evidence provides an insight for pharmaceutical industries and guidance for treatment prescription by physicians aiming to address the public health emergency of treatment non-adherence.<\/jats:p>","DOI":"10.3390\/pharmaceutics13101539","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:30:33Z","timestamp":1632443433000},"page":"1539","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Does the Vehicle Matter? Real-World Evidence on Adherence to Topical Treatment in Psoriasis"],"prefix":"10.3390","volume":"13","author":[{"given":"Ana","family":"Teixeira","sequence":"first","affiliation":[{"name":"Instituto de Investiga\u00e7\u00e3o e Forma\u00e7\u00e3o Avan\u00e7ada em Ci\u00eancias e Tecnologias da Sa\u00fade (IINFACTS), Instituto Universit\u00e1rio de Ci\u00eancias da Sa\u00fade, CESPU, 4585-116 Gandra, Portugal"},{"name":"Laborat\u00f3rio de Tecnologia Farmac\u00eautica, MedTech, UCIBIO-REQUIMTE, Departamento de Ci\u00eancias do Medicamento, Faculdade de Farm\u00e1cia, Universidade do Porto, 4050-313 Porto, Portugal"}]},{"given":"Maribel","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Instituto de Investiga\u00e7\u00e3o e Forma\u00e7\u00e3o Avan\u00e7ada em Ci\u00eancias e Tecnologias da Sa\u00fade (IINFACTS), Instituto Universit\u00e1rio de Ci\u00eancias da Sa\u00fade, CESPU, 4585-116 Gandra, Portugal"}]},{"given":"Vera","family":"Almeida","sequence":"additional","affiliation":[{"name":"Instituto de Investiga\u00e7\u00e3o e Forma\u00e7\u00e3o Avan\u00e7ada em Ci\u00eancias e Tecnologias da Sa\u00fade (IINFACTS), Instituto Universit\u00e1rio de Ci\u00eancias da Sa\u00fade, CESPU, 4585-116 Gandra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3906-0775","authenticated-orcid":false,"given":"Rita","family":"Gaio","sequence":"additional","affiliation":[{"name":"Centro de Matem\u00e1tica, Departamento de Matem\u00e1tica, Faculdade de Ci\u00eancias, Universidade do Porto, 4169-007 Porto, Portugal"}]},{"given":"Tiago","family":"Torres","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo Ant\u00f3nio, 4099-001 Porto, Portugal"}]},{"given":"Sofia","family":"Magina","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Dermatologia, Centro Hospitalar de S\u00e3o Jo\u00e3o, Departamento de Farmacologia e Terap\u00eautica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"}]},{"given":"C\u00e1tia","family":"Cunha","sequence":"additional","affiliation":[{"name":"Servi\u00e7os Farmac\u00eauticos, Centro Hospitalar do T\u00e2mega e Sousa, 4564-007 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-8397","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Sousa Lobo","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Tecnologia Farmac\u00eautica, MedTech, UCIBIO-REQUIMTE, Departamento de Ci\u00eancias do Medicamento, Faculdade de Farm\u00e1cia, Universidade do Porto, 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1498-048X","authenticated-orcid":false,"given":"Isabel F.","family":"Almeida","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Tecnologia Farmac\u00eautica, MedTech, UCIBIO-REQUIMTE, Departamento de Ci\u00eancias do Medicamento, Faculdade de Farm\u00e1cia, Universidade do Porto, 4050-313 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Almeida, V., Leite, A., Constante, D., Correia, R., Almeida, I.F., Teixeira, M., Vidal, D.G., Pedrosa e Sousa, H.F., Dinis, M.A.P., and Teixeira, A. (2020). The mediator role of body image related cognitive fusion in the relation between disease severity perception, acceptance and psoriasis disability. Behav. Sci., 10.","DOI":"10.3390\/bs10090142"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/13548506.2020.1741655","article-title":"Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients","volume":"26","author":"Almeida","year":"2021","journal-title":"Psychol. Health Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1046\/j.1365-2230.2001.00832.x","article-title":"Psoriasis\u2014Epidemiology and clinical spectrum","volume":"26","author":"Christophers","year":"2001","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rendon, A., and Sch\u00e4kel, K. (2019). Psoriasis Pathogenesis and Treatment. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20061475"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/09546634.2019.1617830","article-title":"Is topical treatment effective for psoriasis in patients who failed topical treatment?","volume":"32","author":"Okwundu","year":"2021","journal-title":"J. Dermatol. Treat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1080\/09546634.2016.1254331","article-title":"Worldwide utilization of topical remedies in treatment of psoriasis: A systematic review","volume":"28","author":"Svendsen","year":"2017","journal-title":"J. Derm. Treat."},{"key":"ref_7","first-page":"5","article-title":"The Evolution of Topical Formulations in Psoriasis","volume":"23","author":"Kuehl","year":"2018","journal-title":"Ski. Ther. Lett."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1468-3083.2011.04060.x","article-title":"Maximizing patient adherence for optimal outcomes in psoriasis","volume":"25","author":"Bewley","year":"2011","journal-title":"J. Eur. Acad. Derm. Venereol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.2147\/PPA.S117006","article-title":"Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: A systematic review of the literature","volume":"10","author":"Rivera","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/jdv.12445","article-title":"Non-adherence and measures to improve adherence in the topical treatment of psoriasis","volume":"28","author":"Zschocke","year":"2014","journal-title":"J. Eur. Acad. Derm. Venereol."},{"key":"ref_11","unstructured":"(2021, June 30). European Network to Advance Best Practices & Technology on Medication Adherence 2020. Available online: https:\/\/www.cost.eu\/cost-action\/european-network-to-advance-best-practices-technology-on-medication-adherence."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e016982","DOI":"10.1136\/bmjopen-2017-016982","article-title":"Economic impact of medication nonadherence by disease groups: A systematic review","volume":"8","author":"Cutler","year":"2018","journal-title":"BMJ Open"},{"key":"ref_13","unstructured":"Council of Europe (2019). European Pharmacopoeia, Council of Europe. [10th ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1208\/s12249-018-1246-2","article-title":"Mechanical properties of topical anti-psoriatic medicines: Implications for patient satisfaction with treatment","volume":"20","author":"Teixeira","year":"2019","journal-title":"AAPS PharmSciTech"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1080\/09546634.2018.1544410","article-title":"Patient preferences for attributes of topical anti-psoriatic medicines","volume":"30","author":"Vasconcelos","year":"2018","journal-title":"J. Dermatol. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1111\/jdv.13230","article-title":"Real-life effectiveness of once-daily calcipotriol and betamethasone dipropionate gel vs. ointment formulations in psoriasis vulgaris: Final analysis of the 52-week PRO-long study","volume":"29","author":"Lambert","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/jdv.13859","article-title":"Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: Randomized, controlled PSO-ABLE study","volume":"31","author":"Paul","year":"2017","journal-title":"J. Eur. Acad. Derm. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.ad.2012.12.005","article-title":"Adherence and Patient Satisfaction with Topical Treatment in Psoriasis, and the Use, and Organoleptic Properties of Such Treatments: A Delphi Study with an Expert Panel and Members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology","volume":"104","author":"Puig","year":"2013","journal-title":"Actas Dermosifiliogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1468-3083.2011.04061.x","article-title":"What is new in topical therapy for psoriasis?","volume":"25","author":"Reich","year":"2011","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s13555-016-0119-4","article-title":"Patient Preferences for Topical Psoriasis Treatments are Diverse and Difficult to Predict","volume":"6","author":"Iversen","year":"2016","journal-title":"Dermatol. Ther. (Heidelb)"},{"key":"ref_21","first-page":"304","article-title":"Calcipotriene 0.005%\u2014Betamethasone dipropionate 0.064% ointment versus topical suspension in the treatment of plaque psoriasis: A randomized pilot study of patient preference","volume":"94","author":"Sandoval","year":"2014","journal-title":"Cutis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/095466301317085345","article-title":"Calcipotriol cream in the morning and ointment in the evening: A novel regimen to improve compliance","volume":"12","author":"Franssen","year":"2001","journal-title":"J. Dermatol. Treat."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jdermsci.2016.02.008","article-title":"Methodologies for medication adherence evaluation: Focus on psoriasis topical treatment","volume":"82","author":"Teixeira","year":"2016","journal-title":"J. Derm. Sci."},{"key":"ref_24","unstructured":"Teixeira, A., Teixeira, M., Almeida, V., and Almeida, I.F. (2017). Adherence to topical treatment in psoriasis. Adherence to Medical Plans for an Active and Healthy Ageing, Nova Science Publishers."},{"key":"ref_25","unstructured":"Ribeiro, C., Pereira, A., Martins, S., Teixeira, A., and Almeida, V. (2012, January 26\u201328). Severidade da psor\u00edase: Um estudo de valida\u00e7\u00e3o do \u00cdndice Autoadministrado da \u00c1rea e Severidade da Psor\u00edase. Proceedings of the V Congresso Internacional de Psicologia Cl\u00ednica, Santander, Spain."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/1523-1747.ep12329912","article-title":"The self-administered psoriasis area and severity index is valid and reliable","volume":"106","author":"Feldman","year":"1996","journal-title":"J. Investig. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/1523-1747.ep12384205","article-title":"Patient measurement of psoriasis disease severity with a structured instrument","volume":"102","author":"Fleischer","year":"1994","journal-title":"J. Investig. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1111\/j.1365-4632.2008.03753.x","article-title":"A comparison between BSA, PASI, PLASI and SAPASI as measures of disease severity and improvement by therapy in patients with psoriasis","volume":"47","author":"Henseler","year":"2008","journal-title":"Int. J. Derm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1001\/archderm.139.3.353","article-title":"Performance of the self-administered Psoriasis Area and Severity Index in evaluating clinical and sociodemographic subgroups of patients with psoriasis","volume":"139","author":"Sampogna","year":"2003","journal-title":"Arch. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/jid.1964.57","article-title":"The Weights of Topical Preparations Required for Total and Partial Body Inunction","volume":"42","author":"Schlagel","year":"1964","journal-title":"J. Investig. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1365-2230.1991.tb01232.x","article-title":"The finger-tip unit\u2014a new practical measure","volume":"16","author":"Long","year":"1991","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1001\/archderm.1992.01680180125022","article-title":"The Rule of Hand: 4 Hand Areas=2 FTU=1 g","volume":"128","author":"Long","year":"1992","journal-title":"Arch. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s40257-017-0272-2","article-title":"Development and Validation of a Novel Questionnaire for Adherence with Topical Treatments in Psoriasis (QATOP)","volume":"18","author":"Teixeira","year":"2017","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1468-3083.2012.04525.x","article-title":"Adherence to topical treatment in psoriasis: A systematic literature review","volume":"3","author":"Devaux","year":"2012","journal-title":"J. Eur. Acad. Derm. Venereol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Babar, Z.-U.-D. (2015). Qualitative methods in pharmacy practice research. Pharmacy Practice Research Methods, Springer.","DOI":"10.1007\/978-3-319-14672-0"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1001\/archderm.140.4.408","article-title":"Objective Assessment of Compliance with Psoriasis Treatment","volume":"140","author":"Zaghloul","year":"2004","journal-title":"Arch. Dermatol."},{"key":"ref_37","first-page":"25","article-title":"Medication Adherence: We Didn\u2019t Ask and They Didn\u2019t Tell","volume":"20","author":"Brown","year":"2013","journal-title":"Fam. Pract. Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1468-3083.2005.01329.x","article-title":"How patients experience psoriasis: Results from a European survey","volume":"19","author":"Adjadj","year":"2005","journal-title":"J. Eur. Acad. Derm. Venereol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jaad.2005.12.021","article-title":"Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis","volume":"55","author":"Brown","year":"2006","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/j.1468-3083.2007.02425.x","article-title":"Adherence to treatment in patients with psoriasis vulgaris: Turkish experience","volume":"22","author":"Gokdemir","year":"2008","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s12272-010-2236-4","article-title":"Rheological evaluation of petroleum jelly as a base material in ointment and cream formulations: Steady shear flow behavior","volume":"33","author":"Park","year":"2010","journal-title":"Arch. Pharm. Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Teixeira, A., Teixeira, M., Herdeiro, M., Vasconcelos, V., Correia, R., Bahia, M., Almeida, I., Vidal, D., Sousa, H., and Dinis, M. (2021). Knowledge and Practices of Community Pharmacists in Topical Dermatological Treatments. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18062928"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s13555-015-0087-0","article-title":"An Applicator Delivery System for Fixed-Combination Calcipotriene Plus Betamethasone Dipropionate Topical Suspension (Gel): Innovating Psoriasis Vulgaris Treatment through Patient Collaboration","volume":"5","author":"Rasmussen","year":"2015","journal-title":"Dermatol. Ther. (Heidelb)"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Rocha, \u00c1., Adeli, H., Dzemyda, G., Moreira, F., and Ramalho Correia, A.M. (2021). Mobile System for Personal Support to Psoriatic Patients. Trends and Applications in Information Systems and Technologies, Proceedings of the WorldCIST: World Conference on Information Systems and Technologies (WorldCIST 2021), Terceira Island, Portugal, 30 March\u20132 April 2021, Springer. Advances in Intelligent Systems and Computing.","DOI":"10.1007\/978-3-030-72654-6"}],"container-title":["Pharmaceutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4923\/13\/10\/1539\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:03:34Z","timestamp":1760166214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4923\/13\/10\/1539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,23]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["pharmaceutics13101539"],"URL":"https:\/\/doi.org\/10.3390\/pharmaceutics13101539","relation":{},"ISSN":["1999-4923"],"issn-type":[{"value":"1999-4923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,23]]}}}