Get In First: A Derm's Case for Early Psoriasis Treatment

Addressing psoriasis early in its course may lead to prolonged remission and better outcomes, and dermatologists should take note, according to a presentation at the 2025 American Academy of Dermatology Annual Meeting in Orlando.

Dr. Richard G.B. Langley, MD, FRCPC, a dermatologist, director of research in skin and cutaneous science, and professor of medicine at Dalhousie University in Halifax, Nova Scotia, gave a presentation at the meeting advocating for early intervention in psoriasis management. A recurring theme in the talk was the extent to which early treatment of psoriasis can significantly enhance patient outcomes, not only by improving quality of life but also by reducing the risks of systemic complications.

“Once the disease is established, it’s significantly more difficult to treat,” Dr. Langley said, citing studies suggesting untreated psoriasis over time can lead to structural changes at the cellular and molecular levels, which are harder to reverse. Early treatment within the first two years of disease onset, he said, offers dermatologists an opportunity to mitigate these effects and improve both clinical outcomes and long-term health.

Dr. Langley highlighted findings from pivotal studies such as the STEP-IN and GUIDE trials, which both supported the benefits of early intervention. Results from the studies suggested the early use of systemic treatments, including biologics targeting IL-23, can disrupt disease pathways and reduce the disease burden. Specifically, tissue-resident memory cells (TRMs), which play a key role in psoriasis recurrence, can be effectively targeted using these therapies. 

Real-world Harm

To illustrate the real-world impact of delayed treatment, Dr. Langley shared a case study of a patient of his who endured severe psoriasis for decades without effective intervention. The untreated disease not only caused physical discomfort, but also significantly affected his social and emotional well-being (characterized by chronic alcohol use and damaged social relationships), ultimately contributing to an early death.

“This case underscores the importance of timely intervention, not just to alleviate symptoms but to enhance overall longevity and life satisfaction,” Dr. Langley said.

Wider Trends

Beyond individual cases, Dr. Langley highlighted broader trends in the field. Recent studies have linked severe psoriasis to increased risks of ischemic heart disease and other systemic conditions. He noted that the American Cardiovascular Society now lists psoriasis as a risk enhancer for heart disease, underlining the systemic impact of the condition.

Dr. Langley also addressed the common concern among patients about treatment risks, particularly the long-term safety of biologics. Drawing on his clinical experience working with biologics for more than two decades, he pointed out that these treatments have demonstrated excellent safety profiles and cautioned that the risks of not treating psoriasis early could outweigh the risks associated with therapy.

“The question isn’t just about managing potential side effects,” Dr. Langley said. “It’s about improving lives now and preventing future complications. By delaying treatment, we risk not only worsening disease progression but also shortening life expectancy.”

What Should Derms Do?

Concluding, Dr. Langley urged dermatologists to rethink their approach to psoriasis management by prioritizing early intervention to transform the trajectory of the disease for patients.

"Research demonstrates systemic treatment was protective against mortality, confirming a favorable risk-benefit profile," he said. "Early treatment may result in skin disease that has a higher response rate and chance for remission."

Regarding a future direction for researchers and practitioners, Dr. Langley said the findings from some recent preliminary studies on preventing disease/comorbidity progression could "change our fundamental approach to the treatment of moderate-to-sever psoriasis, suggesting treatment with systemic agents may improve both quality and quantity of life." -by Eric Raible

Source: Langley R.  Early Treatment of Psoriasis: A Window of Opportunity? Presented at: 2025 AAD Annual Meeting, March 7-11, 2025; Orlando.