The fact that it is slow to respond, even when we use isotretinoin- accutane it takes months and months for you to see full benefit. The improvement, even when the maximum treatment is used is maybe 25% per month. That's very very long. So there is this in-built frustration that things are not moving quickly enough and it's a pain to have to keep on using therapy. The big issue also with topical therapy is that it is potentially irritating. Benzoyl peroxide and Vitamin A products dry the skin make the skin red, and can irritate the skin so the inclination is not to want to put it all over. Frequently we have patients coming in just putting the drugs, the topicals on the spots only. It doesn't work. You have to think of these topicals as preventative--it has to be all over the skin. Then if that causes drying, you tend to back off and get very frustrated by it. We know that acne has a huge impact on the self-confidence, and performance of individuals. The severity of acne doesn't always correlate with how badly teens feel about their acne. The other aspect to this is acute onsets--the acne is doing well, but it flares up--and there's this frustration that develops "I've been using this stuff, why isn't it working?" I can fully understand why that occurs. I think we have to explain from the very beginning that this is a slow preventative process that will take months and try to help individuals with how to cope with the dryness. There are many tricks that can be done here. On f you are using an irritating product, apply it on an unwashed face and wash it off after 5 minutes initially and get used to it. It's like training to run a marathon. You start off with small distances and increase it. I encourage my patients to do the same thing with their topicals.