Topical therapy has an important role in psoriasis treatment. It is efficacious and has a favorable safety profile as demonstrated in clinical trials. However, poor treatment outcomes from topical therapy regimens likely result from poor adherence and ineffective use of the medication. The International Psoriasis Council Topical Therapy Working Group has developed a new model to describe the complex interactions among patient, disease, and treatment characteristics, adherence behavior, and treatment outcomes. Recommendations are provided that may assist the health care provider in encouraging adherent behavior in their patients. By understanding and manipulating the factors that affect treatment adherence, improvement in adherence is possible and hence better control and outcomes in the topical treatment of psoriasis are likely.