BACKGROUND: Treatment of patients with psoriasis vulgaris exhibiting only solitary plaque-stage lesions might become difficult since topical treatments often fail and systemic therapies seem inappropriate. OBJECTIVE: We evaluated the feasibility of ablative techniques in this clinical setting comparing dermatome shaving to the application of an Er:YAG laser. METHODS: Six patients were treated by means of dermatome shaving; in four of these patients additional lesions were ablated utilizing an Er:YAG laser (2 J, 10 Hz, 5 mm spot size). RESULTS: Four of six patients experienced complete clearance of the lesions treated, three of the four patients receiving additional Er:YAG treatment also showed a complete clinical response. CONCLUSION: Our observations document that removal of epidermis and the papillary dermis is effective in treating recalcitrant psoriatic plaques. The Er:YAG laser represents a state-of-the-art device for performing this task. The beneficial effect on skin might be due to clearance of the putative autoantigen along with a considerable part of the potential effector cell population.