BACKGROUND Individuals with psoriasis often report significant psychological distress, physical disability, social strain and reduced quality of life. Little is known about how they cope with the illness. OBJECTIVE The primary aim of this study is to determine whether patients' efforts to cope with psoriasis are associated with better or worse health-related quality of life (HRQL). METHODS Focus groups identified seven commonly used coping strategies that were subsequently measured, along with HRQL and other variables, in a survey of 318 individuals with psoriasis. RESULTS Results revealed: (i) that psoriasis is associated with decrements in all quality of life domains that were assessed, and (ii) that commonly used coping strategies such as telling others about psoriasis, covering the lesions and avoiding people were associated with greater decrements in HRQL after controlling for covariates; however, telling others that psoriasis is not contagious was associated with smaller HRQL decreases. CONCLUSIONS How patients cope with the social aspects of psoriasis is associated with their quality of life.