Kwatra SG, Feldman SR
Too often chronic skin disease, particularly extensive disease, does not improve with topical therapy alone, which typically is thought to be due to the ineffectiveness of the medication, the resistance of immune cells, or the failure to treat the entire field of involvement. These explanations lead physicians to think that patients may need more potent and risky treatments, systemic therapies, or other approaches that address the entire field of disease. However, in many cases treatment failure is not caused by resistant disease but by failure to treat.
Listen to Dr. Feldman's audiocast on patient adherence to treatment here.