Editor The guidelines for psoriasis treatment are a useful instrument that provides advice on clinical and scientific aspects and can be used by clinicians as a therapeutic tool. For this reason, it is important to take into consideration the fact that by the time the guidelines are published, they are often outdated. The S3 guidelines raise a number of key questions: There is no support, in the published literature on the use of biologics in psoriasis, for separating induction therapy from maintenance therapy. Nowhere in the labels of the current biologic agents, does the word induction appear. With the proposed publication of S3 maintenance guidelines, it is possible that guidance will be different for starting and maintaining therapy, even if the patient is doing well clinically; and this is contrary to the practice of medicine. With regard to a chronic disease, which may require therapy over several years, consideration would have to be given to any long-term safety issues or loss of effectiveness over time. The current guidelines only look at induction therapy based upon short-term efficacy (12–16 weeks) measured via the PASI 75 response. In clinical practice, measuring short-term efficacy success is generally decided within the first 6 months of treatment, using a combination of the physician’s assessment, supplemented by the outcomes reported by the patient, so that the physician may provide individualized care. PASI75 as an endpoint was developed for regulatory purposes to assess whether a new potential medicine has a useful clinical effect. In a clinical setting, the rigid application of the PASI75 response at an arbitrary point in time means to deny consideration of any other important aspects of management, such as the ability to interrupt therapy, long-term safety, the patient’s preference. As long as the treatment is safe and effective, and a good patient-physician relationship persists, then it would appear appropriate to continue with any treatment already started, in keeping with the need to manage a chronic condition like psoriasis in the long-term. In the S3 guidelines, there appears to be a lack of harmonization and an inconsistency across the description of the biologics. First of all, the literature for some biologics stop up to October 2007while for others, includes studies up to 2008. Second, even if there was an harmonization in the subchapter regarding TBC testing, vaccination and malignancy, the considerations explored in the summary are completely inconsistent with what is reported in those subchapters. Moreover, on this important topic, these guidelines do not consider the large amount of data that Official Registries continuously provide us1,2. This could be a big lack of information resulting in an inaccurate advice to clinicians who are willing to use this document in their clinical practice. Based on the above considerations, Etanercept should be ‘recommended’ and not just ‘suggested’ as an induction treatment because of the following points: Short-term efficacy success is generally decided within the first 24 weeks of treatment. Indeed, the study of van de Kerkhof3 on Etanercept shows a PASI 75 in 71% of patients at this time point. In clinical practice, a suitable therapy should be based on a variety of parameters, including safety, dermatologists’ experience and, last but not the least, patient comorbidities. Etanercept is the biologic that has been used to treat psoriasis over the longest term as well as to treat paediatric patients.