We developed an optimal radiation protocol of bath-PUVA therapy for psoriasis in Japan as referring British and Japanese guidelines. We intended for a total of 100 refractory patients with psoriasis and analyzed it as a retrospective observational study. The following 3 protocols were employed for this study. In all protocols, the initial exposure dose was 0.2 J/cm
2 and the maximum exposure dose was 4.0 J/cm
2. Inprotocol1, the fixed increment dose was used as 0.3 J/cm
2 and the patients were irradiated 4 times a week. In protocol 2 and 3, the gradually increased increment was 0.3–0.7 with J/cm
2 and the patients were irradiated 4 times a week (protocol 2) and 5 times a week (protocol 3). In all protocols, the remission rate was achieved in about 90% without obvious adverse effects. The remission duration was 4.0–6.6 months with protocol 1 and 2. In protocol 3, the period of hospitalization to achieve remission was 36.5 days and significantly shorter than those of the other protocols. The number of irradiation in protocol 3 was 20 and significantly shorter than that of protocol 1. The total cumulative dose in protocol 3 was the smallest in 56.4 J/cm
2. The combination effect of calcipotriol ointment with bath-PUVA therapy showed almost equal to that of maxacalcitol ointment in the remission rate, the duration of hospitalization and the number of irradiation. This result indicated that safe and effective bath-PUVA therapy can be performed in Japan by introducing protocol 3.
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