Background: Psoriasis is a common chronic inflammatory skin condition that varies in severity; it affects 2–3% of the population. Visfatin a 52-kDa protein has been recently identified as an adipocytokine secreted primarily by visceral adipose tissue and various cells such as neutrophils, monocytes, macrophages, epithelial, endothelial cells and also present in the circulation in various inflammatory conditions. It is related to insulin resistance, obesity, atherosclerotic diseases and type II diabetes. Visfatin is assumed to be closely associated with the metabolic syndrome in addition to its role in inflammatory diseases, role in renal injury and in apoptosis. Objectives: The aim of the present study is to estimate visfatin levels in serum and tissue (lesional and non-lesional) of psoriatic patients and to correlate these levels with markers of the metabolic syndrome and disease severity. Patients and methods: This study was done on 30 psoriatic patients. Serum and tissue visfatin levels were measured by Enzyme Linked Immunosorbent Assay (ELISA) technique. All patients were subjected to clinical examination in which all criteria of metabolic syndrome were assessed including anthropometric data, blood pressure, lipid profile and fasting blood sugar. Results: In this study lesional and non-lesional tissue visfatin was significantly higher than serum. Patients with dyslipidemia and those fulfilling criteria of metabolic syndrome exhibited highly significant lesional tissue visfatin which wasn’t the case for both serum and non-lesional tissue levels. No correlation was detected between tissue and serum visfatin levels with any of the demographic data, anthropometric measures, dyslipidemia, metabolic syndrome and related disorders except for a positive correlation between serum and tissue visfatin levels with disease extent and Psoriasis Area and Severity Index (PASI) score. Moreover high density lipoprotein (HDL) showed negative correlation with lesional tissue visfatin. Conclusion: Patients with psoriasis are at increased risk of metabolic and cardiovascular complications. Lesional tissue visfatin is rather more specific to factors conveying cardiovascular risk in our patients' series.