Notes: The treatment of limited extent plaque psoriasis in the majority of cases is a routine procedure for dermatologists and only a small number of patients need a change of the chosen regimen. However, in patients with widespread plaque psoriasis treatment can be hampered for various reasons; in particular, the use of a systemic regimen or UV light and all their combination modalities may be restricted by individual factors such as concomitant diseases, personal risk factors and previous treatments. In another group of psoriasis patients with high disease activity and frequent relapses after each treatment course effective intervention can be difficult. In mild forms of plaque psoriasis a combination of different topical agents, mainly with sequential use, are given. For several of these combinations like such as D3 and its analogues, and topical corticosteroids clinical studies have shown synergistic mechanisms. A next step of treatment is the introduction of occlusive treatment. In moderate plaque psoriasis topical agents are usually combined with W-light (LTVB or PUVA). Salt-water bathing plus UVB is an alternative modality. For severe forms of plaque psoriasis systemic compounds are combined with topical agents. The systemic retinoid acitretin may also be combined with PLIVA. In very severe cases the combination of systemic compounds such as cyclosporin and methotrexate may be adequate. Initial treatment with new biological compounds such as monoclonal antibodies targeting multifunctional cytokines such as tumour necrosis factor α, or which interfere with T-cell activation (interleukin-2 receptor antibodies) seems to be highly effective in active or triggered severe plaque psoriasis. A better definition of the type of psoriasis in the individual patient, as well as the recognition of risk and trigger factors, will help in choosing ‘tailored’ therapy. Records of previous treatment results further help to define an individual pattern of plaque psoriasis which may enable the dermatologist to predict treatment outcome with a good reliability. Combination of different regimens, rotation between them and sequential use of systemic registered compounds may help to prevent refractory diseases states. The limited use of new biological compounds may further help to treat patients with a history of unresponsive plaque psoriasis.