The future management of psoriasis will depend on a number of distinct but ultimately inter-related strands of evidence, these are: (i) the interplay of genes and environment and the characterisation of psoriasis phenotypes; (ii) the role of pharmacogenetics in personalised healthcare; (iii) the translation of basic scientific discovery of relevant immune and angiogenic pathways into targeted biologic and small molecule therapies; and (iv) the recognition that the management of any chronic disease is enhanced by an understanding of psychosocial issues. A reductionist approach to development of new therapies will be paramount but serendipity and the prepared mind will contribute, as they have always done.