OBJECTIVES: This study examined if patients with severe psoriasis were treated in accordance with therapy/medications as per guidelines recommended by the American Academy of Dermatology (AAD) (i.e. receive either phototherapy or systemic treatment). METHODS: A survey for this study was conducted by the National Psoriasis Foundation between November and December 2004. Respondents, screened for a mix of gender and age, were interviewed over the phone (n=188) and by online surveys (n=212). Information on current medication use was obtained. Self-reported Body Surface Area (BSA) involvement was used to measure severity of psoriasis. BSA of greater than 10% is indicative of severe psoriasis. Severity was also assessed more globally using the Koo-Mentor Psoriasis Index (KMPI). KMPI scores of 50 and above are suggestive of significant negative health related quality of life and warrant initiation of systemic therapy. Cross sectional nature of this study permitted analysis of patients with severe psoriasis only. Descriptive data were generated to determine demographic characteristics of study population and prescription patterns. RESULTS: Approximately 55% of the population had severe psoriasis as measured by BSA, while 75% had severe psoriasis as per KMPI scores. About 19% of the study population indicated that they were currently not on any treatment. Almost 15% of the patients with severe psoriasis identified with BSA (n=212) and KMPI (n=299) were on some form of topical therapy alone to treat their psoriasis (i.e. they were not treated in accordance to the AAD guidelines.). CONCLUSION: AAD guidelines provide a standard for psoriasis treatment options and conditions for their prescriptions. Even with such easily accessible guidelines in place, this study has shown that there are several people suffering from severe psoriasis that are not on recommended therapy.