OBJECTIVES: Psoriasis (PsO) is a chronic, episodic, immunological skin disease that affects approximately 2-2.5% of US population. It may result in work productivity loss and high overall healthcare costs for employers. However, the impact on health-risks is not well studied. We compared health-risks, lost productivity, and total direct healthcare costs among individuals with PsO and five most prevalent chronic conditions. METHODS: Health-risk information and self-reported illness days using health-risk assessment (HRA) data were examined and direct Healthcare costs (medical and pharmacy) using claims data for employees, retirees, and their adult dependents of a large self-insured employer were compared from 2002-2006 among individuals with RA and five most prevalent chronic conditions; asthma, coronary artery disease/congestive heart failure (CAD/CHF), diabetes, hypertension, chronic obstructive pulmonary disease (COPD).   RESULTS: 54 individuals with PsO were identified. The PsO cohort had moderate health-risk score (2.8/5) which was comparable to individuals with asthma (2.8/5), CHF (2.9), hypertension (2.6) and lower than diabetes (3.2/5) and COPD (3.4/5). A higher proportion (35.2%) of individuals with PsO had >5 illness days per year as compared with individuals with asthma (31.8%), CAD/CHF (25.9%), hypertension (20.4%), diabetes (28.4%), and COPD (33%). Annual direct healthcare costs were also higher for individuals with RA ($28,933) as compared to individuals with asthma ($25,814), CAD/CHF ($22,916), hypertension ($18,632), and diabetes ($28,224), and lower as compared to individuals with COPD ($38,839). CONCLUSIONS:  Individuals with PsO have similar health-risks but higher illness days, and direct healthcare costs as compared to the individuals with five most prevalent chronic conditions. Psoriasis is a high costs and lost productivity driver for employers. Population health based programs that engage employees in appropriately managing their chronic conditions can help employers reduce health-risks, improve productivity, and may help reduce healthcare costs as well.