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Background: Psoriasis is a chronic inflammatory disease characterized by a variable clinical course and the need for long-term management. Over time, patients may require escalation from topical to systemic therapies depending on disease severity and progression. Objective: To evaluate treatment patterns according to disease duration in patients with psoriasis. Methods: A retrospective observational study was conducted including patients with clinically confirmed psoriasis. Disease duration was determined based on time of evolution and categorized into two groups: ≤2 years and >2 years. Treatment modalities analyzed included topical therapy, conventional systemic therapy, biologic therapy, and phototherapy. Comparisons between groups were performed using descriptive statistics and chi-square tests, with statistical significance defined as p < 0.05. Results: A total of 549 patients were included, of whom 490 (89.3%) had a disease duration greater than 2 years and 59 (10.7%) had a duration of 2 years or less. Patients with longer disease duration (>2 years) demonstrated a higher use of systemic therapies, including biologic treatment (11.8% vs 8.5%, p = 0.583) and conventional systemic therapy (38.0% vs 30.5%, p = 0.329), compared with those with shorter disease duration (≤2 years). In contrast, phototherapy was more frequently used in patients with shorter disease duration (32.2% vs 22.2%, p = 0.122). Topical therapy use was similar between groups (89.8% vs 88.6%, p = 0.943). Overall, no statistically significant differences in treatment patterns were observed according to disease duration. Conclusions: Disease duration was not significantly associated with treatment patterns in this cohort of patients with psoriasis. Although patients with longer disease duration showed a numerical tendency toward greater use of systemic and biologic therapies, these differences did not reach statistical significance. These findings suggest that treatment selection in this population may be influenced by factors other than duration alone, such as disease severity, comorbidity burden, treatment access, or physician preference. Further studies incorporating severity measures and longitudinal follow-up are needed to better clarify the relationship between disease duration and therapeutic escalation.