A retrospective case study of 39 patients with severe recalcitrant chronic plaque psoriasis (CPP) treated with adalimumab between 2005 and 2008 was conducted. All patients had failed on previous systemic therapies, including biologics in 59%. Fourteen patients received combined treatment with other systemic therapies. The mean duration of treatment was 61.5 weeks (range 25-102). The initial adalimumab dose was 40 mg/week or every 2 weeks as clinically indicated. The main outcome measure was the Psoriasis Area and Severity Index (PASI); an improvement of 75% or more (PASI75) was noted as a successful outcome. In the adalimumab monotherapy group PASI75 was achieved by 38, 62, 69 and 71% at weeks 16, 24, ...