Psoriasis is a chronic inflammatory disease with a major impact on the quality of life of patients. Its management remains a real challenge. The aim of our study is to evaluate the place of methotrexate in the treatment of moderate to severe psoriasis in our Moroccan context. We obtained good results with a complete remission in 50% of the cases, with few side effects thanks to a regular follow-up of our patients, as well as their supplementation in folic acid. Biotherapies are as effective as methotrexate with fewer side effects, however their cost remains high and they are not reimbursed by social security. In our context, methotrexate remains the first-line treatment for moderate to severe psoriasis, it is an effective, low-cost and well-tolerated treatment.