Improving Dermatology Treatment Adherence Through Motivational Interviewing

Dear Editor,

Chronic dermatologic conditions often require long-term management and face the challenge of maintaining patient engagement over time. Motivational interviewing (MI) is an evidence-based communication method designed to address patient hesitance toward behavior change. ¹ Rather than the traditional directive approach, MI incorporates a collaborative style that elicits the patient’s own desires for self-improvement. ¹ Chronic dermatologic conditions are common and require long-term adherence, yet, current adherence ranges from only 40% to 60%. ² Adherence challenges may be due to out-of-pocket treatment costs, limited access to dermatologic care and follow-up, medication side effects, and low patient motivation or treatment fatigue. This can lead to more serious consequences for patients at higher risk of infection or malignancy. Research shows that regular sunscreen use can reduce the risk of squamous cell carcinoma by up to 40% and melanoma by 50%, yet many patients do not apply it consistently. ³ Dermatologists can play a vital role in this process when interacting with their patients. Rather than using a judgmental tone and confrontational questions about adherence, they can use MI to invite patients to share their goals and concerns, aligning treatment with the patient’s motivations.

MI has been successful in areas of medicine such as cardiology, and new evidence is emerging that it holds increasing potential in dermatology. The PsoWell program in the United Kingdom trained dermatology clinicians in MI techniques and evaluated their skills and knowledge in managing psoriasis and its comorbidities. ⁴ Clinicians who participated in a brief MI workshop reported greater confidence in addressing patient adherence, treatment, lifestyle changes, and self-management. ⁴ Key MI strategies, such as reflective listening and open-ended questions, engage the patient in brainstorming solutions. When patients articulate personal goals like, “I want clearer skin before my wedding,” they can experience better treatment adherence, as voicing their motivation strengthens their commitment.

A systematic review by Frost et al found that MI is particularly effective in helping patients stop unhealthy behaviors such as smoking and substance use. ⁵ This can be relevant for dermatology, where behavior change often involves discontinuing harmful habits rather than just starting new treatments. For example, patients may require support in reducing chronic scratching, avoiding tanning beds, or discontinuing the use of harmful products. In conditions such as eczema or psoriasis, behavioral changes, such as reducing scratching, are essential for disease improvement alongside pharmacologic adherence.

An example of using MI in dermatology is outlined in Supplemental Figure 1. This 4-stage framework (engage, focus, evoke, plan) shows how a clinician might foster adherence to daily sunscreen use through a collaborative conversation. By asking patients what changes they would like to make, how confident they feel on a scale of 0 to 10, and whether they would like to revisit the plan together, dermatologists can foster stronger engagement with minimal time investment.

MI introduces a practical, patient-centered approach to improve engagement and long-term adherence in chronic dermatologic diseases. Integrating MI into residency training and clinical practice can shift adherence conversations from instruction to collaboration, supporting long-term dermatologic disease control.