OBJECTIVES: Psoriasis is a significant economic burden to both patients and payers in terms of direct and indirect costs. Previous systematic reviews have been limited with regards to geographical region of assessment and type of economic outcomes reported. Hence, the objective of this systematic review is to provide a global comprehensive understanding of the direct and indirect economic burden of psoriasis.  METHODS: A systematic literature search was conducted and studies were identified from PubMed and conference proceedings. Studies published in English language between January 2001 and May 2013, and reporting direct and indirect economic burden of psoriasis were identified using search strategies. A total of 1,181 abstracts were screened by two researchers; any discrepancy was resolved by a third researcher. RESULTS: Forty studies (34 primary articles and 6 conference abstracts) from 12 countries including 19 from the US, 4 from Canada, 3 from Germany, 2 each from Italy, Netherlands and the UK, 1 each from Australia, Brazil, Israel, Spain, Sweden and Switzerland, and 2 multinational studies met the inclusion criteria. Overall, 27 studies assessed direct costs, 3 studies assessed indirect costs, and 10 studies evaluated both. Major contributors of direct costs included medication costs, office visits, hospitalization costs and monitoring costs. Productivity loss, patient and caregiver work days lost, and restricted activity days were key drivers of indirect costs. Among the European countries, the most recent studies reported an annual total cost (direct and indirect cost) per patient of €11,928 in Sweden, €8,372 in Italy, and €2,866 - €6,707 in Germany based on treatment type. In US and Canada, the annual direct and indirect economic burden of psoriasis was $1.4 billion and CDN$1.7 billion respectively. CONCLUSIONS: Costs associated with chronic plaque psoriasis are high in many countries indicating a continued need for new treatments.