Eighty-four patients with severe psoriasis who required methotrexate (MTX) therapy have been reviewed. A total of 134 liver biopsies were performed. The lack of correlation between alcohol intake and the use of potential hepatotoxic drugs with pretreatment liver biopsies is noted. A review of 30 patients who had liver biopsies performed before and after MTX treatment showed no statistically significant difference between the histological grades before and after treatment. Nor was there any absolute correlation between the cumulative MTX doses and the histological changes of follow-up biopsies. In this group of patients, 15 (50%) developed fibrosis, which was severe in 2 patients, after 3,431 mg MTX average dose. Cirrhosis was observed in 3 patients (10%) after 1,667 mg MTX average dose. Follow-up liver biopsies are recommended for patients treated with MTX.