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Although many treatment methods for psoriasis are available, it is still a challenging task for the dermatologist to choose the optimal one. To the best of our knowledge, there was only 1 small study of head-to-head comparison of the efficacy of these medications to date. In this retrospective study, we compared the clinical efficacy and recurrence rates of narrow-band ultraviolet B (NB-UVB) and methotrexate (MTX) treatments for plaque-type psoriasis. Sixty-seven patients with psoriasis who received NB-UVB (n = 35) or MTX (n = 32) treatments were included in the study. Response was assessed by Psoriasis Area and Severity Index (PASI) at baseline, 4th and 12th week. Our results revealed that both treatment modalities significantly reduced the PASI score compared with baseline (P < 0.001 and P < 0.001, respectively). Moreover, there was no significant difference between both regimens regardless of baseline PASI scores (P = 0.796 at 4th week and P = 0.606 at 12th week). Recurrence rates in both treatments were also similar at 3 months (42.9% for NB-UVB and 65.2% for MTX, P = 0.162). In conclusion, the use of NB-UVB can be considered as a preliminary treatment method rather than MTX when taking into account of the lower side effect profile even in patients with severe psoriasis.