<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">Health</journal-id><journal-title-group><journal-title>Health</journal-title></journal-title-group><issn pub-type="epub">1949-4998</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/health.2015.712192</article-id><article-id pub-id-type="publisher-id">Health-62315</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  Comparative Study on Management of Vitiligo with Psoralen plus Steroid (Oxabet Formula) Alone VS Psoralen Formula plus Narrow Band of Ultraviolet B 311 nm in Khartoum Teaching Hospital of Dermatology and Venereology (KTHDV)
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>ussein</surname><given-names>Salman Mohammed</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Jahelrasoul</surname><given-names>Abdalla Edriss</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff2"><addr-line>Dermatology and Venereology, KTHDV, Khartoum, Sudan</addr-line></aff><aff id="aff1"><addr-line>Dermatology and Venereology, OIU, Khartoum, Sudan</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>dardaka@gmail.com(USM)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>09</day><month>12</month><year>2015</year></pub-date><volume>07</volume><issue>12</issue><fpage>1763</fpage><lpage>1773</lpage><history><date date-type="received"><day>24</day>	<month>July</month>	<year>2015</year></date><date date-type="rev-recd"><day>accepted</day>	<month>26</month>	<year>December</year>	</date><date date-type="accepted"><day>29</day>	<month>December</month>	<year>2015</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  A comparative study and management has been conducted in (KTHDV). For some patients who attend the out patients clinic concern on treatment of the vitiligo with a new formula (Oxabet) alone VS Oxabet (oxpsolaren plus betamethasone) formula plus NB. UVB311 is during a period from (Jan 2011-Jan 2013). The study sample includes different age groups of both sexes. The study revealed that the formula alone gives good results. The localized vitiligo has a good response to the formula than generalized one. The early lesions have good responses than the old ones. The continuations of applying the treatment and the follow up of the patients enhance the efficacy of the treatment.
 
</p></abstract><kwd-group><kwd>Vitiligo</kwd><kwd> Oxabet Formula</kwd><kwd> L.V. (Localize Vitiligo)</kwd><kwd> G.V. ( Generalize Vitiligo)</kwd><kwd> Leukoderma</kwd><kwd> Psoralen</kwd><kwd> NB UVB 311nm</kwd><kwd> PUVA</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Vitiligo is specific common, and often is a heritable or acquired disorder of the skin and mucous membranes, characterized by well circumscribed milky white cutanous macules and patches devoid of identifiable melenocytes [<xref ref-type="bibr" rid="scirp.62315-ref1">1</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref3">3</xref>] . The likely incidence is between 1% - 2% [<xref ref-type="bibr" rid="scirp.62315-ref4">4</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref6">6</xref>] . All races are affected. Both sexes are affected equally [<xref ref-type="bibr" rid="scirp.62315-ref7">7</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref8">8</xref>] . Vitiligo may develop at any age, and the average age of onset is 20 years [<xref ref-type="bibr" rid="scirp.62315-ref9">9</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref11">11</xref>] . Extensive trials of treatment have been done, which are rarely successful [<xref ref-type="bibr" rid="scirp.62315-ref12">12</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref14">14</xref>] .</p><p>Clinical types:</p><p>1) Localized:</p><p>a) Focal vitiligo</p><p>b) Segmental vitiligo [<xref ref-type="bibr" rid="scirp.62315-ref15">15</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref17">17</xref>]</p><p>2) Generalized:</p><p>a) Vulgaris vitiligo</p><p>b) Lip-tip vitiligo</p><p>c) Arcofacial vitiligo</p><p>d) Universal vitiligo [<xref ref-type="bibr" rid="scirp.62315-ref18">18</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref19">19</xref>]</p></sec><sec id="s2"><title>2. Psoralean Compounds</title><p>Tricyclic furocoumarin-like molecules found naturally in a variety of plants throughout the world and also produced synthetically [<xref ref-type="bibr" rid="scirp.62315-ref21">21</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref22">22</xref>] , radically increase the erythema response of skin to long-wave ultraviolet light (UVA) after either topical application or systemic administration [<xref ref-type="bibr" rid="scirp.62315-ref2">2</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref23">23</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref25">25</xref>] .</p><p>Types: 3-TMP, 5-MOP, 8-MOP yjey are used with phototherapy or heliotherapy or bulb [<xref ref-type="bibr" rid="scirp.62315-ref26">26</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref27">27</xref>] .</p></sec><sec id="s3"><title>3. Management</title><p>Various options are available Topical phototherapy, Systemic therapy, Surgical, Depigmentation, Laser therapy (Excimer 308 nm) [<xref ref-type="bibr" rid="scirp.62315-ref28">28</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref30">30</xref>] .</p><p>This study is conducted from a MD study: 8-MOP plus Betamethazone (Oxabet) topical alone or with UVB Narrow Band 311 nm [<xref ref-type="bibr" rid="scirp.62315-ref2">2</xref>] -[<xref ref-type="bibr" rid="scirp.62315-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref31">31</xref>] [<xref ref-type="bibr" rid="scirp.62315-ref32">32</xref>] .</p></sec><sec id="s4"><title>4. Methodology</title><p>For the formula tests had been carried out on 20 volunteer patients. The study had been accomplished in Khartoum teaching hospital of dermatology and venereology (KTHTV).</p><p>The study was done during a period of three months by evaluation the treatment of vitiligo with psoralen plus steroid alone and psoralen plus steroid with N.B UVB311 nm.</p><p>The patients were selected among the patients revising the outpatients clinic in Khartoum hospital of dermatology.</p><p>The number for sampling were (100) patients.</p><p>The patients had been requested to sign a consent paper.</p><p>The patients had been divided in two groups, a psoralen plus steroid and B psoralen plus steroid plus NB UVB311 nm.</p><p>The result had been tabulated, analyzed and discussed according to the study.</p><p>Lastly the conclusion and recommendation had been added</p><p>The drug was composed of 8 methoxalen powder 0.3 g in 20 g betamethazone.</p><p>Both drugs were marketed in the Sudan, their effect in vitiligo is summative i.e. they increase the devision of melanocytes and enhance the number of melanocytes in leukodermic area, and increase synthesis of the melanin (melanogenesis). The steroid therapy acts against autoantibodies of melanocytes (immunomodulators). The treatment name we suggest for the formula is (Oxabet).</p></sec><sec id="s5"><title>5. Results</title><p>38 of the adult patients had localized vitiligo (L.V.) and were treated with formula as group A, who gave results as follows:</p><p>35 of patients had complete healing and 3 of them had marked improvement. (See Figures 1-13).</p><p>35 of the adult patients had generalized vitiligo (G.V.) who were treated with formula as group B and gave results as follows:</p><fig id="fig1"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref></label><caption><title> Lower limbs before treatment with Oxabet formula plus UVB NB 311 nm</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x6.png"/></fig><fig id="fig2"  position="float"><label><xref ref-type="fig" rid="fig2">Figure 2</xref></label><caption><title> Lower limbs before treatment with Oxabet formula plus UVB NB 311 nm</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x7.png"/></fig><fig id="fig3"  position="float"><label><xref ref-type="fig" rid="fig3">Figure 3</xref></label><caption><title> Lower limbs after three months of treatment with Oxabet formula plus UVB NB 311 nm had completely healing</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x8.png"/></fig><p>20 of them had complete healing, and 15 of them had good improvement (see Figures 14-18)).</p><p>The children treated with formula as group A and gave results as follows:</p><p>20 of patients had complete healing, 5 patients had good results and 2 patients had been resistance to the treatment. The (L.V.) patients gave good results rather than the (G.V.) (See <xref ref-type="fig" rid="fig1">Figure 1</xref>9 and <xref ref-type="fig" rid="fig2">Figure 2</xref>0).</p><p>M.B. all patients are have no associated problems.</p><p>Patient not responding to treatment with a formula should anxiety.</p><p>Although the results are promising, yet we cannot guaranty to prevent the recurrence.</p><p>The lesions need 2 - 3 moths to heal.</p><p>Children have better results than adults.</p><p>The drug can cause contact eczema noticed in three children and two adults.</p><fig id="fig4"  position="float"><label><xref ref-type="fig" rid="fig4">Figure 4</xref></label><caption><title> A child group A before treatment with Oxabet formula plus UVB NB 311 nm (acral lesion)</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x9.png"/></fig><fig id="fig5"  position="float"><label><xref ref-type="fig" rid="fig5">Figure 5</xref></label><caption><title> A child group A after three months of treatment with Oxabet formula plus UVB NB 311 nm had improvement</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x10.png"/></fig><fig id="fig6"  position="float"><label><xref ref-type="fig" rid="fig6">Figure 6</xref></label><caption><title> Adult female group A before treatment with Oxabet formula</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x11.png"/></fig><fig id="fig7"  position="float"><label><xref ref-type="fig" rid="fig7">Figure 7</xref></label><caption><title> adult female group A after three months of treatment with Oxabet formula had completely healing</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x12.png"/></fig><fig id="fig8"  position="float"><label><xref ref-type="fig" rid="fig8">Figure 8</xref></label><caption><title> Acral vitiligo, adult male group A before treatment with Oxabet formula</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x13.png"/></fig><fig id="fig9"  position="float"><label><xref ref-type="fig" rid="fig9">Figure 9</xref></label><caption><title> Acral vitiligo, adult male group A after three months of treatment with Oxabet formula had completely healing</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x14.png"/></fig><fig id="fig10"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>0</label><caption><title> Acral Vitiligo, adult male group A before treatment with Oxabet formula</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x15.png"/></fig><fig id="fig11"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>1</label><caption><title> Acral Vitiligo, adult male group A after three mon- ths of treatment with Oxabet formula had complete healing</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x16.png"/></fig><fig id="fig12"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>2</label><caption><title> Acral vitiligo partially responding to Oxabet theraby</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x17.png"/></fig><fig id="fig13"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>3</label><caption><title> Acral vitiligo partially repigmented with Oxabet and UVB</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x18.png"/></fig><fig id="fig14"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>4</label><caption><title> Acral vitiligo treated with Oxabet and UVB. Improvement in the legs but the feet are resistant to treatment</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x19.png"/></fig><fig id="fig15"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>5</label><caption><title> Slow response to treatment</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x20.png"/></fig><fig id="fig16"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>6</label><caption><title> Generalised vitiligo before treatment</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x21.png"/></fig><fig id="fig17"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>7</label><caption><title> Generalised vitiligo after one month with Oxabet treatment</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x22.png"/></fig><fig id="fig18"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>8</label><caption><title> Focal vitiligo resistant to treatment with Oxabet</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x23.png"/></fig><fig id="fig19"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>9</label><caption><title> Adult female group A before treatment with Oxabet formula</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x24.png"/></fig><fig id="fig20"  position="float"><label><xref ref-type="fig" rid="fig2">Figure 2</xref>0</label><caption><title> Adult female group A after three months of treatment with Oxabet formula had complete healing</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/20-8203390x25.png"/></fig><p>Acral vitiligo is difficult to heal.</p></sec><sec id="s6"><title>6. Discussions</title><p>This study is a pilot one so far no recorded formula or study in a literature is found.</p><p>The formula gave a good result in the treatment of the (L. V.) than the G. V.</p><p>The children gave good results than the adult. The formula with combination of NB. UVB311 used in the treatment of G. V. and gave less degree than the formula alone.</p></sec><sec id="s7"><title>7. Conclusions</title><p>The formula has a good promise for a future of treatment of vitiligo. It gives good results in shorter times around 3 months. It has an affordable price. It is easy to prepare apply with less side effect. The formula of Oxabet is stable up to six months at room temperature, but we prefer not to use it beyond three months.</p><p>As far as I know, there is no similar study in the literature, so it is considered as a pilot study.</p><p>The idea for the formula has been inspired from personal experience in dermatology. That is to say, both drugs are prescribed to treat vitiligo through:</p><p>a) Helping in division of melanocytes</p><p>b) Assisting in melanogensis</p><p>c) Transferring of melanin</p><p>d) Immunomodulators</p><p>So the reaction 8s is additive and summative.</p></sec><sec id="s8"><title>Recommendations</title><p>The formula initially should be kept at 8 degree ˚C shouldn't be used after 3 months until the preserving time is reported. The patients should be followed up for recurrent or permanent healing. If the recurrent occurs the patients should repeat a fresh sample of drug.</p></sec><sec id="s9"><title>Cite this paper</title><p>Hussein SalmanMohammed,Jahelrasoul AbdallaEdriss, (2015) Comparative Study on Management of Vitiligo with Psoralen plus Steroid (Oxabet Formula) Alone VS Psoralen Formula plus Narrow Band of Ultraviolet B 311 nm in Khartoum Teaching Hospital of Dermatology and Venereology (KTHDV). Health,07,1763-1773. doi: 10.4236/health.2015.712192</p></sec></body><back><ref-list><title>References</title><ref id="scirp.62315-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Lestery, M. and Alikhan, A. (2011) A Comprehensive Overview Part II Treatment Options and Approach to Treatment. 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