Etanercept has been proven to be highly effective to moderate severe plaque psoriasis. Alternative biologics or combination therapies of etanercept with other systemic agents have been recommended to patients who are unable to be controlled by etanercept monotherapy. A 50-year-old woman, who did not respond to conventional therapy of psoriasis for 9 years, was treated with etanercept at a schedule of 50 mg doses per week. Psoriatic lesions were remarkably improved within two weeks after etanercept monotherapy, but skin lesions aggravated again 8 weeks after treatment. Then, she was treated with 50 mg etanercept in combination with 5 mg methotrexate per week. Psoriatic lesions were successfully controlled by the combination therapy for 6 weeks, followed by etanercept monotherapy without relapse for the past 13 months. We report the first Korean case of refractory psoriasis, which could be successfully controlled by combination therapy of etanercept with low doses of methotrexate.