SummaryBackground There are few reports of the practical use of adalimumab outside a clinical trial setting and, to our knowledge, none from the U.K. Objectives We assessed the efficacy and safety of adalimumab in a cohort of patients with severe psoriasis attending a tertiary dermatology referral centre in the U.K. Methods A retrospective case-note review was used to identify all patients initiated on adalimumab for psoriasis. Results Mean ± SD baseline Psoriasis Area and Severity Index (PASI) score was 24 ± 11 (range 9-54; n = 46). After 4 months' treatment with adalimumab, 64% (29/45) of patients had achieved PASI 75 (75% decrease from baseline) while 80% (36/45) of patients met National Institute for Health and Clinical Excellence (NICE) criteria for continuation of treatment. The therapy was well tolerated. Importantly, 68% (21/31) of patients who had previously received another tumour necrosis factor-α inhibitor met NICE criteria for continuation of treatment at 16 weeks. Conclusions In a cohort of U.K. patients with severe psoriasis, adalimumab has proved to be a significant addition to the expanding armamentarium of biologics for psoriasis. Pharmacovigilance, in the form of registries, is essential to assess the long-term safety of such drugs. © 2010 British Association of Dermatologists.