Psoriasis is a chronic proliferative skin disorder with reported incidence of 1.5%-4.8% in different countries. Its etiology is still unknown, while genetic, metabolic and immunological mechanisms have been recommended as its causes. Literatures suggest that lipid metabolism may play a significant role in pathogenesis of psoriasis, and psoriatic patients manifest significant lipid abnormalities. Comorbidities (cardiovascular diseases) were reported in psoriatic patients. Different therapeutic trials on psoriasis were made to find an effective and safe antipsoriatic agent. Statins, in addition to the hypolipemic effect, show immunomodulating effects that encourage their use in many autoimmune diseases. Atorvastatin was reported to have a therapeutic efficacy in many immune diseases that related to psoriasis in pathogenesis (e.g. rheumatoid arthritis), that encourage to using it in psoriasis. Isotretinoin was reported to show a restricted antipsoriatic efficacy and used in combination with other antipsoriatic agents. Dyslipidemia and increasing the atherosclerotic index was reported with isotretinoin. Aim of study was to assess efficacy of atorvastatin in treatment of psoriasis and its role in improving dyslipidemia (seen in psoriasis) in comparison to isotretinoin and to assess lipid profile in Iraqi psoriatic patients, and whether it is related to the severity of disease, and correlated with other psoriasis biomarker (TNF alpha). Patients and Methods.The study comprised 53 psoriatic patients and 50 age and sex matched healthy subjects and baseline characteristics for all contributors were reported. Psoriatic patients were subclassified by two ways, firstly psoriatic patients were classified according to the modules of treatment in to A (on placebo), B (on atorvastatin) and C (on isotretinoin), and secondly psoriatic patients were classified according to the severity of disease in to mild to moderate and severe cases. All the patients were satisfied three successive visits. In each visit, clinical assessment by using PASI (psoriasis area and severity index) score was performed, and fasting blood sampling were collected to assess the lipid profile, TNF alpha, hemoglobin (Hb), liver function tests (LFT), and renal functions tests (RFT). Results Atorvastatin showed poor antipsoriatic efficacy in comparison to isotretinoin that showed higher efficacy in improving psoriasis. Psoriatic patients, in comparison to healthy subjects, showed a significant high serum level of total cholesterol (TCH) and low-density lipoprotein cholesterol (LDL) and no significant differences in the serum level of triglyceride (TG), very low-density lipoprotein cholesterol (VLDL), and high-density lipoprotein cholesterol (HDL). Also, psoriatic patients showed a significant higher atherosclerotic index and higher serum level of tumor necrosis factor (alpha) and both later parameters were related to psoriasis severity. Severe cases were found to be associated with significant lower serum level of HDL. Atorvastatin (in comparison to baseline and placebo) significantly decreased the serum level of TCH and LDL, and significantly increased serum level of HDL. Furthermore, atorvastatin significantly decreased atherosclerotic index and has no significant effects on serum level of TNF-α. Isotretinoin shows no significant effects on lipid profile and atherosclerotic index in comparison to baseline, and a slightly significant elevation in TCH, TG, LDL, and VLDL, but no significant effects on atherosclerotic index in comparison to placebo group. Isotretinoin significantly decreased serum level of TNF-α in comparison to baseline and placebo group. Conclusions Psoriatic patients were showed lipid abnormalities and high atherosclerotic index that such patients may suffer from future atherosclerotic diseases. Atorvastatin showed a beneficial therapeutic role in psoriasis by its hypolipemic efficacy and decreasing atherosclerotic index thereby reducing the established risks of comorbidities (atherosclerotic diseases) associated with psoriasis. In contrast, although the isotretinoin showed antipsoriatic efficacy, it may worsen the lipid profile in psoriatic patients. Further studies were recommended to assess the antipsoriatic effect of statins.