Background:Researchers have indicated that 30-40%of patients with psoriasis suffer significant psychological distress. For the appropriate clinical managem ent of the patient with psoriasis it is important that dermatologists are able t o recognize this distress. Objectives:To examine the level of agreement between dermatologists and patients with psoriasis as to the presence of clinically sig nificant psychological distress. Methods:Forty-three consultations between der matologists and patients with psoriasis were assessed. Following the consultatio n two assessments were undertaken:the patients completedmeasuresofanxietyanddep ression,andtheconsulting dermatologists recorded whether they believed the patie nt to be psychologically distressed and, if so, their subsequent action. Attheen dofthestudy,alldermatologistswhoparticipated completed the Jefferson Scale of Ph ysician Empathy. Results:Self-report questionnaires indicated that 37%and 12 %of patients were identified as probable clinical cases for anxiety and depress ion, respectively. In general, the level of agreement between patient rating and dermatologist rating as to the presence of anxiety or depression was low (kappa statistic 0.24 and 0.26, respectively). Dermatologist empathy level did not app ear to influence identification of distress. In only 39%of cases were the psych ological difficulties of significantly distressed patients raised by dermatologi sts during the consultation. Conclusions:Agreement between dermatologists and p atients with psoriasis regarding the presence of clinically significant psycholo gical distress was low. When dermatologists did identify patients as being anxio us and/or depressed, in the majority of cases no further action was taken follow ing the consultation. This study highlights a number of areas for improvement in the psychological management of patients with psoriasis. Background: Researchers have indicated that 30-40% of patients with psoriasis suffer significant psychological distress. For the appropriate clinical managem ent of the patient with psoriasis it is important that dermatologists are able to recognize this distress. Objectives: To examine the level of agreement between dermatologists and patients with psoriasis as to the presence of clinically sig nificant psychological distress. Methods: Forty-three consultations between der matologists and patients with psoriasis were assessed. the patients completedmeasuresofanxietyanddepration, andtheconsulting dermatologists recorded. whether they believed the patie nt to be psychologically distressed and, if so, their subsequent action. Attheen dofthestudy, alldermatologistswhoparticipated completed the Jefferson Scale of Phsician Empathy. Results: Self-report questionnaires indicated that 37% and 12% of patients were identified as probable cl in general cases for anxiety and depress ion, respectively. In general, the level of agreement between patient rating and dermatologist rating as to the presence of anxiety or depression was low (kappa statistic 0.24 and 0.26, respectively). Dermatologist empathy level did not app ear to influence identification of distress. In only 39% of cases were the psychological of of significantly distressed patients raised by dermatologi sts during the consultation. Conclusions: Agreement between dermatologists and p atients with psoriasis regarding the presence of clinically significant psycholo gical distress was low When dermatologists did identify patients as being anxio us and / or depressed, in the majority of cases no further action was taken follow ing the consultation. This study highlights a number of areas for improvement in the psychological management of patients with psoriasis.