Dermatologists are being urged to ditch the "step-up" approach to psoriasis and start patients on biologic treatments earlier. Real-world data show that early biologic use leads to significantly better skin clearance and fewer comorbidities. Experts say it's time for dermatology to follow the lead of rheumatology and gastroenterology.
At the British Association of Dermatologists 2026 Annual Meeting, leading dermatologist Chris Griffiths called for a fundamental shift in how psoriasis is managed — moving away from the slow, stepwise "staircase" approach and toward an "elevator" model that gets patients onto the right treatment, including biologics, as early as possible.
The case for early intervention is backed by growing evidence. Real-world data from the British Association of Dermatologists Biologics Register (BADBIR) found that patients started on biologics as first-line therapy had dramatically better outcomes than those who began with conventional treatments — and were less likely to develop serious comorbidities.
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Why it matters: Psoriasis is a lifelong systemic disease, and delays in optimal treatment can lead to lasting physical and psychological harm. Shifting to earlier biologic therapy could meaningfully improve patient outcomes and reduce the long-term burden of comorbidities.
