Background: Psoriasis is a chronic inflammatory dermatological disease with a strong genetic predisposition and autoimmune pathogenic traits. The hallmark of psoriasis is sustained inflammation that leads to uncontrolled keratinocyte proliferation and dysfunctional differentiation. Objective: The aim of this study was to evaluate serum level of paraoxonase-1 in psoriasis patients compared to control group.  Patients and methods: This research included 50 psoriasis patients and 40 healthy controls that were comparable in age and sex to the cases category. They were chosen at random from the Outpatient Clinic of Dermatology Department, Mansoura University Hospitals. Results: Psoriasis group showed significantly lower level of paraoxonase-1 when compared to control group (median=35.6 versus 54.5; p < 0.001). Additionally, median paraoxonase-1 level decreased gradually with increased psoriasis grades (p < 0.001). No significant associations were found regarding paraoxonase-1 level according to gender, smoking, and FH in psoriasis group (p > 0.05 for each). Paraoxonase-1 level showed significant negative correlation with PASI score (p < 0.001), but not with age, onset, or duration (p > 0.05 for each). Lower paraoxonase-1 level was considered as independent predictor of psoriasis development. Lower paraoxonase-1 level was considered as independent predictor of psoriasis severity (p < 0.001). Conclusion: Paraoxonase-1 level in psoriasis patients had substantially lower levels than healthy controls. Paraoxonase-1 level showed significant negative correlations with PASI score. Lower baseline paraoxonase-1 level was suggested to be independent risk predictor for psoriasis occurrence and severity.