Grenz ray therapy has declined in the United States during the past several decades with respect to availability, use, and resident training. However, it remains a simple, affordable, and effective option for managing several refractory dermatoses, especially psoriasis, hand eczema, and allergic contact dermatitis. Though high-dose grenz irradiation has been associated with the development of nonmelanoma skin cancers, grenz ray therapy is considered a safe treatment modality when administered according to the guidelines recommended herein. We review the value of grenz irradiation in contemporary dermatology.