BACKGROUND: Inpatient hospital care was a traditional approach to treat severe psoriasis. Since 1980, only modest innovations in psoriasis therapy have been introduced, but regulation and financing of inpatient hospital care have changed greatly. OBJECTIVE: We documented changes in the use of inpatient care in acute care hospitals for psoriasis in a cohort of individuals with severe psoriasis and nationally. METHODS: Using interviews, we quantified hospitalizations for psoriasis and other reasons among the PUVA Follow-up Study cohort. We used National Hospital Discharge Survey data to determine national trends in hospitalization rates. RESULTS: In 2 decades, national rates of hospitalization primarily for psoriasis decreased more than 80%. Among our cohort of persons with severe psoriasis, the age-adjusted rate of hospital days for psoriasis decreased more than 60% during this period. CONCLUSION: Currently, hospitalization in acute care hospitals is seldom used to care for persons with psoriasis.