Background: Grenz ray therapy (GRT) has been used for inflammatory and neoplastic dermatologic diseases for over 100 years. Its use is declining, possibly because of the difficulties maintaining radiation certification and insurance coverage. Objective: The aim of this study is to evaluate the safety and effectiveness of GRT in chronic inflammatory dermatoses of the hands and feet. Methods: We performed a retrospective chart review of patients treated with GRT at the Oregon Health & Science University from 2006 to 2009. Candidates identified for the study were then mailed questionnaires to supplement data acquired from chart review. Results: Most patients (73%; 95% confidence interval [CI], 65%Y80%) experienced at least moderate improvement. This improvement persisted for at least 1 month in 66% of patients (95% CI, 57%Y74%), with 18 patients (23%; 95% CI, 15%Y33%) clear for over 1 year. Minimal adverse effects were reported, and most patients (63%; 95% CI, 52%Y72%) stated that they would repeat GRT if available. Conclusions: Grenz ray therapy seems to be a safe and effective modality for chronic hand and foot dermatoses with some patients experiencing prolonged remissions. Grenz ray therapy, when available, should be considered before the use of systemic agents, which are often associated with higher costs and potential toxicities.