Supplementary Material for: How to Increase Adherence and Compliance in Acne Treatment? A Combined Strategy of SMS and Visual Instruction Leaflet

<b><i>Introduction:</i></b> Acne is a common skin disease with important psychosocial impact. Often inadequate compliance affects the efficacy of the therapy. Because of emerging use of mobile and electronic health technology, the recent literature evaluated the helpfulness of the tools in medication adherence. The first goal of our study was to evaluate the adherence to therapy with topical adapalene 0.3%/benzoyl peroxide (A-BPO) 2.5% in different groups of patients who received explicative information supported by different strategies. The second goal was to evaluate the patient’s quality of life and skin parameters. <b><i>Materials and Methods:</i></b> We enrolled 126 subjects with mild to severe acne vulgaris. They were randomized into 3 groups of 42 patients each and applied daily topical A-BPO (0.3%, 2.5%) for 12 weeks. The first group (G1) was trained on the gel application by an explicative leaflet. The second group (G2) received the same instructions as group 1 and a daily SMS to remind them of the application of the product. The third group (G3) only received standard instructions. Evaluations were performed at the beginning of treatment (T0) and after 12 weeks (T1): assessment of acne severity using the Investigator’s Global Assessment (IGA) Scale for Acne Severity, quality of life by the Cardiff Acne Disability Index (CADI) and the Patient-Doctor Relationship Depth-of-Relationship Scale (PDRDS), skin pH, grade of hydration and adherence to treatment with a 7-day recall calendar were also measured. <b><i>Results:</i></b> After 12 weeks of therapy, we observed a reduction in IGA in all groups confirming the clinical efficacy of the product. In the multiple comparison analysis of IGA score reduction, a significant difference was found in G2 versus G1 and G2 versus G3, while the G1 versus G3 comparison was not statistically significant. However, the leaflet group (G1) showed better results compared to the no-leaflet group (G3). Supporting these data, we observed that adherence days correlated positively with the improvement of the single parameters. Moreover, we observed that SMS and leaflet groups had a greater improvement in quality of life evaluated by CADI and PDRDS scores. <b><i>Conclusions:</i></b> According to our data, this experimental setup based on text message service and leaflet service is inexpensive and easy to use. Physicians could consider using these items in their practice to enhance patient adherence and satisfaction as well as treatment outcome.

**引言：** 痤疮是一种常见皮肤病，对患者社会心理状态具有重要影响。临床中，用药依从性不足常影响治疗效果。随着移动与电子健康技术的普及，近期已有文献评估了相关工具在提升用药依从性方面的价值。本研究的首要目标是，针对采用不同宣教策略的患者群体，评估其对0.3%阿达帕林/2.5%过氧化苯甲酰（A-BPO）外用制剂的治疗依从性；次要目标为评估患者的生活质量与皮肤参数。
**材料与方法：** 本研究纳入126例轻至重度寻常痤疮（acne vulgaris）患者，按1:1:1随机分为3组，每组42例，所有患者每日外用A-BPO制剂（0.3%阿达帕林/2.5%过氧化苯甲酰），连续治疗12周。第一组（G1）通过宣教手册学习凝胶使用方法；第二组（G2）除获得与G1相同的指导外，每日接收用药提醒短信（SMS）；第三组（G3）仅接受标准指导。分别于治疗开始时（T0）及治疗12周后（T1）进行评估：采用痤疮严重程度研究者整体评分法（IGA）量表评估痤疮严重程度，采用卡迪夫痤疮残疾指数（CADI）与医患关系亲密度量表（PDRDS）评估患者生活质量与医患关系，同时检测皮肤pH值、皮肤水合程度，并通过7天回忆日历评估治疗依从性。
**结果：** 治疗12周后，所有组的IGA评分均较基线降低，证实了该制剂的临床疗效。对IGA评分降幅的多重比较分析显示，G2与G1、G2与G3的组间差异均具有统计学意义，而G1与G3的组间差异无统计学意义。不过，宣教手册组（G1）的治疗效果仍优于无宣教手册组（G3）。上述结果与“依从用药天数与各项皮肤参数改善呈正相关”的观察结果一致。此外，接收短信与宣教手册的两组（G1、G2）在采用CADI与PDRDS评分评估的生活质量改善方面更为显著。
**结论：** 基于本研究数据，依托短信服务与宣教手册的干预方案成本低廉且操作简便。临床医师可考虑在诊疗实践中采用此类干预手段，以提升患者治疗依从性、满意度及临床治疗效果。