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All patients with psoriasis would like to rid themselves of it. Some have widespread disease; others have psoriasis only on the scalp or only on the elbows and knees and not elsewhere. Others have a single plaque on the penis. Who has the most severe disease? According to the FDA, severe disease is defined by plaques affecting more than 20% of the total body surface area (BSA). But who is really more severely affected — a patient with psoriasis over 25% of his body who goes about his day undisturbed, in short sleeves and shorts, or a patient with 1% involvement who hides at home and refuses social invitations in shame? In clinical practice, dermatologists routinely take into account the impact of psoriasis on quality of life in determining …