Dermatology services must be organized to meet the needs of patients. These needs change as society changes and medical knowledge increases. Considerable insight into the true needs of individual and groups of patients can be gained from the use of quality of life measures. Patients with widespread inflammatory skin disease are most severely handicapped by their skin disease and can be most helped by dermatology services. It is essential that such patients be given priority in the delivery of dermatological care. Where necessary, protected clinic time and specialist support services should be created to ensure that such patients are not adversely affected by pressures to review patients in other diagnostic groups.