The expression of psoriasis is highly variable and may even differ within a single patient. This comprises not only extent of lesions, severity in terms of erythema induration, and scaling or visibility of the lesions, but particularly the responsiveness to antipsoriatic treatments in the past. Therefore, the management of psoriasis has to reconcile the variability of treatment responses, which, to some extent, may be genetically determined but also are the result of nongenetic factors, including triggering factors and adaptation (habituation) to treatments. In this article, we will provide a patient-based approach on the management of psoriasis, which reconciles the heterogeneity of psoriasis in individual patients. (c) 2008 Elsevier Inc. All rights reserved.