The reason this disease is hard to treat is that it is variable and may involve many tissues and systems. Steroids act quickly but have many side effects (weight gain, bone problems, infection risk), and immunosuppressants and biological agents also have infection and other risks. Usually it is a stepwise treatment: local first, if not enough then systemic drugs, and finally consider biological agents or surgery. The process is like adjusting a complex machine; it can take months or even longer to find the best combination. I changed several drugs; that period felt like trial and error, but it also taught me patience and trust in the doctor’s judgment.