OBJECTIVES: Evaluation of use, dose distribution, and dosing rationale of biologic treatments in plaque psoriasis within private practices and hospitals in Germany.  METHODS: Fully structured Online Questionnaire using Umfragecenter® software. Panel participants were selected by DocCheck Medical Services using their MediAccess Pool. Survey was done in December 2009. 100 dermatologists (60 in private practices, 40 in hospitals) were included in the survey. Inclusion criterion: currently treating at least two psoriasis patients with biologics, at least one patient on adalimumab, etanercept or infliximab. RESULTS: Each surveyed dermatologist treated approximately 100 psoriasis patients per quarter. In private practice about 10% of these patients were treated with a biologic, while in hospitals about 23% received biologic treatment. About 40% of the patients receiving a biologic suffered from psoriatic arthritis as well. Distribution of the different biologics used was as follows: etanercept 37%, adalimumab 33%, infliximab 20%, and ustekinumab 10%. Only minor differences in those proportions were observed between private practices and hospitals. In about 80% of all cases, used dosing for each biologic conformed to the respective label. In other cases, increased dosages were observed, for example: 12% of adalimumab patients received 40mg weekly, 17% of etanercept patients being treated longer than 24 weeks received a 50mg BIW maintenance dose, and 23% of infliximab patients received infusions every 6 weeks. Reasons for dose increase included higher severity of disease, longer disease duration, loss of efficacy, overweight, joint involvement, higher number of previous systemic therapies received. CONCLUSIONS: Real-life dosing of psoriasis biologics does not always conform to the posology recommended in the product label, especially for high need patients. About 20% of patients being treated with a TNF-alpha-inhibitor seem to need a higher non-standard dose.