***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Acne vulgaris can affect adolescents at a time of profound physical , social , and psychological change . The negative impact of acne on self-image and self-confidence can be severe , leading to potential psychiatric problems and limiting social interactions , even in adults . Adherence is necessary for successful treatment of acne , and patient satisfaction is crucial for adherence . The Measuring Acne Outcomes in a Real-World Experience ( MORE ) trial enrolled 1979 subjects who used combination acne treatments , all containing adapalene gel 0.1 % .  Among other measures , subjects were surveyed regarding their satisfaction with treatment . Adherence to treatment protocol was high throughout the study ( 94.5 % and 88.0 % at weeks 6 and 12 , respectively , determined by self-report , and 93.7 % and 80.3 % , respectively , determined by filled prescriptions ) . Of the subjects who completed preference surveys , more than 70 % rated adapalene gel 0.1 % as much superior or superior to other acne treatments ; more than 85 % of subjects were very satisfied or satisfied with adapalene gel 0.1 % to treat their acne ; and more than 85 % of subjects reported feeling more confident or positive after using this treatment . About 75 % of subjects planned to continue using adapalene gel 0.1 % and /or use it in the future if they needed acne treatment , and close to 75 % of subjects indicated that they would recommend this treatment to a friend . The high level of patient satisfaction with adapalene gel 0.1 % as an acne treatment is likely to translate into a high level of adherence to treatment , including maintenance treatment , and a major improvement in quality of life ( QOL ) for patients with acne Background Patient adherence is an important component of the treatment of chronic disease . An underst and ing of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success . Purpose This meta- analysis aims to systematic ally review published r and omized controlled trials of reminder interventions to assist patient adherence to prescribed medications . Methods A Medline search was performed for r and omized controlled trials published between 1968 and June 2011 , which studied the effect of reminder-based interventions on adherence to self-administered daily medications . Results Eleven published r and omized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication  in a group receiving reminder interventions compared to controls receiving no reminders .  Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time . Meta- analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls ( 66.61 % versus 54.71 % , 95 % CI for mean : 0.8 % to 22.4 % ) . Self-reported and electronically monitored adherence rates did not significantly differ ( 68.04 % versus 63.67 % , P = 1.0 ) . Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention . Limitations The data are limited by imperfect measures of adherence due to variability in data collection methods . It is also likely that concomitant educational efforts in the study population s , such as instructions regarding proper administration and importance of correct dosing schedules , contributed to improved patient adherence , both in reminder and control arms . The search strategy could have missed relevant studies which were categorized by disease rather than adherence . Conclusions Reminder-based interventions may improve adherence to daily medications . However , the interventions used in these studies , which included reminder phone calls , text messages , pagers , interactive voice response systems , videotelephone calls , and programmed electronic audiovisual reminder devices , are impractical for widespread implementation , and their efficacy may be optimized when combined with alternative adherence-modifying strategies . More practical reminder-based interventions should be assessed to determine their value in improving patient adherence and treatment outcomes The US Food and Drug Administration has approved adapalene gel 0.1 % for use in the treatment of acne vulgaris .  The objective of our study was to evaluate the efficacy and tolerability of adapalene gel 0.1 % in the treatment of acne vulgaris in a clinical practice . We used a 12-week , multicenter , open-label , noncomparative phase 4 study of adapalene gel 0.1 % . The study involved approximately 600 dermatologists in the United States and included 2,545 healthy men and nonpregnant women older than 14 years who had mild or moderate acne vulgaris . Of the patients enrolled , 75 % completed the study and most of them ( 89 % ) showed an improvement in their acne ( clear of acne or marked , definite , or minimal improvement ) from baseline . Most patients ( 69 % ) were satisfied or very satisfied with adapalene therapy , and most ( 80 % ) wished to continue treatment . Only 3.7 % of patients enrolled reported treatment-related adverse events ( n=94 ) , the most common being skin irritation ( 2.2 % ) . We conclude from this open-label trial in a dermatology practice setting that adapalene gel 0.1 % was effective and well tolerated and had a favorable safety profile . Furthermore , compliance with once-daily application of adapalene was rated as high by 92 % of patients who responded to a self- assessment question naire It is well known that the setting of clinical trials for registration studies do not necessarily represent efficacy seen in clinical practice , where physicians have the flexibility to select , combine , and change the acne treatment prescription . In this phase 4 , open-label , multicenter , community-based study , 544 patients who were dissatisfied with their current acne treatment received tretinoin gel microsphere ( TGM ) 0.04 % or 0.1 % in a pump dispenser for 12 weeks . Patients were allowed the use of up to 2 other concurrent acne therapies , not including other retinoids . A total of 361 patients received TGM  0.04 % and 183 received  TGM 0.1 % . Compliance was high ( defined as 75 % to 100 % of prescribed doses taken ) for approximately 95 % of patients in both groups at every evaluation . At week 12 , the mean modified Global Acne Grade score ( mGAGs ) and the investigator global evaluation ( IGE ) demonstrated significant ( P<.0001 ) improvement from baseline for both concentrations , with 72 % having at least moderate improvement . In approximately 25 % of patients , acne was assessed as cleared or almost cleared . Most side effects were characteristic of topical retinoids . These results indicate TGM in a pump dispenser as an effective , well-tolerated acne treatment that is associated with a high rate of compliance Background : Adherence to treatment is a mayor issue in dermatology , and its relationship to quality of life has barely been studied . Objective : To evaluate the relationship between scores on the Skindex-29 skin disease assessment scale and adherence to treatment in patients with acne . Methods : An observational , prospect i ve study of 1,628 patients carried out by 252 clinicians in Spain . Results : Adherence was related to better objective and subjective severity index scores and better Skindex-29 scale scores at the end of the study . Young , male and unemployed patients had the worst adherence scores . Baseline and final Skindex-29 scale scores were significantly worse in non-adherent females , while non-adherent males scored better . Reasons for non-adherence were side effects for older patients and forgetfulness for younger ones . Conclusion : Dermatologists should explain that adherence to treatment is linked to better outcomes and better quality of life .  Young females with high Skindex-29 scale scores and males with low Skindex scores are especially prone to non-adherence BACKGROUND : Topical retinoid therapy has been shown to be an effective means of treating both the inflammatory and non-inflammatory lesions of acne vulgaris . AIM : To assess the efficacy and safety of the test product , a gel containing isotretinoin 0.1 % w/w and erythromycin 4.0 % w/w , with a currently used and effective treatment for mild to moderate acne vulgaris , a gel containing benzoyl peroxide 5.0 % w/w and erythromycin 3.0 % w/w . METHODS : This multi-centre , single-blind ( investigator blind ) , parallel group study compared the efficacy and safety of isotretinoin/erythromycin gel ( Double Strength IsotrexinA ) once daily against benzoyl peroxide/erythromycin gel ( Benzamycin ® ) twice daily in the topical treatment of mild to moderate acne vulgaris . Patients ( n = 188 ) with a history ( mean duration 3.3 years ) of facial acne vulgaris and with 15 - 100 inflammatory lesions and /or 15 - 100 non-inflammatory lesions , but not more than three nodulocystic lesions , were included . At baseline and weeks 2 , 4 , 8 and 12 , the investigator assessed efficacy ( total number and severity of inflammatory and non-inflammatory lesions and acne grade ) while subjective global change assessment s of facial acne from baseline and symptom-specific skin tolerance were assessed by the patient . The investigator recorded an overall global assessment of skin tolerability at week 12 . Adverse events were recorded throughout . RESULTS : The treatments were comparable with regard to their effects on inflammatory and non-inflammatory lesions and acne grade . Few adverse events were considered to be treatment-related . Both the isotretinoin/erythromycin and benzoyl peroxide/erythromycin gels were generally well tolerated . Compliance was better with the isotretinoin/erythromycin gel , which had the advantages of not requiring mixing or storage in a refrigerator , and was applied once rather than twice daily . CONCLUSIONS : Isotretinoin/erythromycin gel given only once daily showed comparable efficacy  with benzoyl peroxide/erythromycin given twice daily in the treatment of mild to moderate acne vulgaris of the face Introduction : A topical acne treatment in which clindamycin phosphate equivalent to 1 % clindamycin is presented in a gel formulation has received marketing authorizations in a number of EU and non‐EU countries . Clindamycin/zinc gel contains zinc acetate in a formulation that reduces systemic absorption of clindamycin through the skin . Objectives : To compare the efficacy and safety of a 1 % clindamycin/zinc gel when applied to the face once daily or twice daily with a 1 % clindamycin lotion applied twice daily for 16 weeks in patients with mild to moderate acne vulgaris . Methods : This was a r and omized , comparative , observer‐blind , parallel‐group , multicentre study involving 246 acne patients . Results : The study demonstrated therapeutic similarity between clindamycin/zinc gel applied once and twice daily with clindamycin lotion applied twice daily . All three regimens produced a gradual and time‐dependent reduction in inflamed lesions , non‐inflamed lesions and overall grade . Side effects were similar and minimal , consisting predominantly of mild irritant dermatitis . All regimes produced a time‐related significant reduction in skin surface and follicular Propionibacterium spp . and Micrococcaceae . The emergence of resistant strains was less than 5 % and was similar with all three regimes . Conclusion : The equivalent efficacy and safety of clindamycin/zinc gel either once or twice daily to clindamycin lotion twice daily has been demonstrated . It is suggested that a treatment regime of one application per day may significantly enhance compliance and thus treatment success in acne patients BACKGROUND The efficacy of topical medications is limited by non-adherence . Interventions to improve adherence to topical treatments are not well characterized . OBJECTIVE To assess the impact of office visits on patients ' adherence to topical treatment .  METHODS Twenty-nine subjects enrolled in a clinical trial for psoriasis and were followed for up to 8 weeks . Subjects were told to apply 6 % salicylic acid gel twice daily . Electronic monitors were used to assess adherence . Results were compared to adherence in clinical trials of h and dermatitis and atopic dermatitis . RESULTS Adherence rates were significantly higher around the time of office visits ( P < .05 ) . LIMITATIONS This is a small study in a limited patient population . The study was observational and not a r and omized trial of the effect of increased office visits . CONCLUSION Frequent follow-up visits in clinical trials increase patients ' adherence to medications . The use of a follow-up visit shortly after initiating treatment may be an effective way to boost patients ' use of their medication and achieve better treatment outcomes 
    Output:
    
The occurrence of side effects and young age were cited as the top reasons for poor adherence , followed by forgetfulness .
Conclusions Overall , the values reflected a population adherent to both topical and oral medications , with no significant difference in adherence between the two .
However , the method ologies used by many of the studies were weak , and the findings are not consistent with results of more objective measures of adherence .