***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A previous uncontrolled , open trial of levamisole in patients with limited and slowly spreading vitiligo had shown that new lesions did not develop in 94 % of patients after 2–4 months of treatment with the drug Topical tacrolimus was recently introduced as a novel therapeutic option in vitiligo . Excellent results were seen mainly on the face and neck areas . We treated 30 adult vitiligo patients with tacrolimus 0.1 % ointment twice daily , and compared the results with those of placebo ointment . In 20 patients , defined areas on the right arm or leg were occluded overnight with 3 different dressings .  Repigmentation was evaluated quantitatively and qualitatively . Quality of life changes were assessed with the Dermatology Life Quality Index . After 6 months , treatment was stopped in 7 of 30 patients as they did not show any repigmentation , 5 of them had no occlusive therapy . After 12 months , 17 of 21 patients ( 81 % ) with facial involvement showed repigmentation of the face . Although no or minimal repigmentation occurred on the extremities when using tacrolimus ointment alone , 80 % of the patients showed repigmentation on the arms when using additional occlusive , especially hydrocolloid dressings . H and s , feet and lower legs were unresponsive . The best results were obtained in patients with long-st and ing vitiligo . Only minimal side-effects were noted . There was no significant elevation in tacrolimus blood levels , taking into account that occlusion was performed only on limited parts of the body . In conclusion , tacrolimus 0.1 % ointment proved an effective and safe treatment option for adult patients with vitiligo . Beyond the face and neck areas , repigmentation could be achieved only by additional occlusion OBJECTIVE To compare the efficacy of oral psoralen-UV-A ( PUVA ) with that of narrowb and -UV-B ( NB-UVB ) phototherapy in patients with nonsegmental vitiligo . DESIGN Double-blind r and omized study . SETTING Phototherapy unit in a university hospital . PATIENTS Fifty-six patients with nonsegmental vitiligo . Interventions Twice-weekly therapy with PUVA or NB-UVB . MAIN OUTCOME MEASURES The change in body surface area affected by vitiligo and the color match of repigmented skin compared with unaffected skin were assessed after 48 sessions of therapy , at the end of the therapy course , and 12 months after the end of therapy . RESULTS The results in the 25 patients each in the PUVA and NB-UVB groups who began therapy were analyzed . The median number of treatments was 47 in the PUVA-treated group and 97 in the NB-UVB-treated group ( P = .03 ) ; we suspect this difference was because of the differences in efficacy and adverse effects between the 2 modalities , such that patients in the NB-UVB group wanted a longer course of treatment . At the end of therapy , 16 ( 64 % ) of 25 patients in the NB-UVB group showed greater than 50 % improvement in body surface area affected compared with 9 ( 36 % ) of 25 patients in the PUVA group . The color match of the repigmented skin was excellent in all patients in the NB-UVB group but in only 11 ( 44 % ) of those in the PUVA group ( P<.001 ) . In patients who completed 48 sessions , the improvement in body surface area affected by vitiligo was greater with NB-UVB therapy than with PUVA therapy ( P = .007 ) . Twelve months after the cessation of therapy , the superiority of NB-UVB tended to be maintained . CONCLUSION In the treatment of nonsegmental vitiligo , NB-UVB therapy is superior to oral PUVA therapy BACKGROUND Recently , it has been shown that UVB phototherapy may be more effective than UVA in the treatment of vitiligo . Currently , however , no studies have compared the efficacy of UVB311 nm and broad-b and UVB therapy . Calcipotriol has recently been reported to be effective adjunctive treatment for vitiligo , enhancing the efficacy of 8-methoxypsoralen plus UVA ( PUVA ) therapy . METHODS Ten patients were enrolled in the study ; nine completed the 12 months of therapy . The upper part of the body was treated twice weekly with UVB311 nm and the lower part with broad-b and UVB . Calcipotriol was applied onto the vitiligo lesions of the right side of the body and placebo on the left side . Repigmentation was documented by photography , planimetry , and Vitiligo Disease Activity ( VIDA ) score . The quality of life was measured by the Dermatology Life Quality Index ( DLQI ) . RESULTS After 7 - 16 weeks , six of the nine patients showed initial repigmentation on the side treated with UVB311 nm . After 6 months of treatment , none of the patients showed repigmentation on the areas treated with broad-b and UVB , which prompted us to apply UVB311 nm all over the body . At the end of 12 months , two patients showed > 75 % repigmentation , two showed 51 - 75 % , two showed 26 - 50 % , and three showed 0 - 25 % . In all patients with progressive vitiligo ( seven of the nine patients ) , disease activity was stopped . Remarkably , vitiligo lesions treated with calcipotriol initially showed delayed repigmentation compared with control areas ; however , there was no therapeutic difference between calcipotriol and placebo , both in combination with UVB311 nm , by the end of the study . The DLQI score improved significantly by an average of 28 % . Conclusion UVB311 nm therapy was effective in the treatment of vitiligo , whereas broad-b and UVB had no effect . Combination with calcipotriol ointment was not superior to UVB311 nm monotherapy . The quality of life significantly improved with narrow-b and UVB311 nm phototherapy BACKGROUND The first choice treatment for vitiligo vulgaris is narrow-b and UVB ( NB-UVB ) , but no satisfactory treatment exists . OBJECTIVES To investigate if Polypodium leucotomos , an antioxidative and immunomodulatory plant extract , improves NB-UVB-induced repigmentation . METHODS Fifty patients with vitiligo vulgaris r and omly received 250 mg oral P. leucotomos or placebo three times daily , combined with NB-UVB twice weekly for 25 - 26 weeks . RESULTS Repigmentation was higher in the P. leucotomos group vs. placebo in the head and neck area ( 44 % vs. 27 % , P = 0.06 ) . Small repigmentation increases ( P = n.s . ) were observed for the trunk ( 6 % increased repigmentation ) , extremities ( 4 % ) , and h and s and feet ( 5 % ) in the P. leucotomos group vs. placebo . Patients attending more than 80 % of required NB-UVB sessions showed increased repigmentation in the head and neck area in the P. leucotomos group vs. placebo ( 50 % vs. 19 % , P < 0.002 ) ; no significant differences were seen in the other body areas . Patients with skin types 2 and 3 showed more repigmentation in the head and neck area in the P. leucotomos group vs. placebo ( 47 % vs. 21 % , P = 0.01 ) , and no significant differences were seen in the other body areas . No conclusions could be drawn on skin types 4 and 5 due to low patient numbers . CONCLUSION There is a clear trend towards an increase in repigmentation of vitiligo vulgaris affecting the head and neck area when NB-UVB phototherapy is combined with oral P. leucotomos . This effect may be more pronounced in light skin types Vitiligo is a progressive condition involving a loss of pigmentation in the skin ; it can be disfiguring and no effective treatment or cure exists . Although vitiligo 's medical effects have been studied extensively , little attention has been paid to its psychological impact or to the effects of psychological state on the illness itself . To address these issues , the present study examined the effect of cognitive behavioural therapy on coping with vitiligo and adaptation to the negative effects on body image , quality of life and self-esteem in adult patients . The study also examined whether any psychological gains acquired from psychological therapy would influence the progression of the condition itself . Two matched groups of vitiligo patients were compared , one of which received cognitive-behavioural therapy over a period of 8 weeks , while the other received no changes to their treatment status . All patients were assessed on self-esteem , body image and quality of life , prior to , immediately following and 5 months following the end of therapy . The progression of the condition was assessed by photographing patients prior to the start of counselling and 5 months following counselling . Results suggest that patients can benefit from cognitive behavioural therapy in terms of coping and living with vitiligo . There is also preliminary evidence to suggest that psychological therapy may have a positive effect on the progression of the condition itself . Implication s for incorporating psychological counselling into patient care and management are discussed BACKGROUND Monobenzylether of hydroquinone is used worldwide to remove residual pigment in patients with vitiligo universalis . Because of the side effects reported with this drug , the use of monobenzylether of hydroquinone has been restricted in The Netherl and s. OBJECTIVE Our purpose was to evaluate the long-term effectiveness and safety of a combination therapy consisting of topical 4-methoxyphenol ( 4-MP ) cream and Q-switched ruby ( QSR ) laser in 16 patients with vitiligo universalis . METHODS In a retrospective study , patient record forms were evaluated . Data were collected regarding history as well as physical and histologic examination . The patients came to the institute for a follow-up visit after a treatment-free period of 2 to 36 months . RESULTS Thirteen patients received both therapies . Three patients only used the cream . None of the areas was treated by the cream and QSR laser at the same time . In 11 of the 16 patients ( 69 % ; 95 % confidence interval [ CI ] , 41%-89 % ) total depigmentation was achieved using the 4-MP cream .  Onset of depigmentation was between 4 and 12 months . Four of the 5 patients who did not respond to the 4-MP cream had successful depigmentation with the QSR laser .  Mild burning or itching was reported with the cream in 4 cases ( 25 % ) . Of the 11 patients who responded to the 4-MP cream , 4 had recurrence of pigmentation ( relapse rate of 36 % ; 95 % CI , 11%-69 % ) after a treatment-free period of 2 to 36 months . In 9 of the 13 patients ( 69 % ; 95 % CI , 39%-91 % ) total depigmentation was achieved after QSR laser therapy .  Onset of depigmentation was between 7 and 14 days after the treatment . Three of the 4 unresponsive patients showed total depigmentation after application of the 4-MP cream . No side effects were observed . Of the 9 patients who responded to QSR laser therapy , 4 had recurrence of pigmentation ( relapse rate of 44 % ; 95 % CI , 14%-79 % ) after a treatment-free period of 2 to 18 months . These patients had a negative Koebner phenomenon . CONCLUSION Depigmentation therapy using a 4-MP cream and /or QSR laser therapy is an effective and safe method to remove disfiguring residual pigment in patients with vitiligo universalis . Patients should be warned that repigmentation may occur , even after total depigmentation has been achieved 
    Output:
    
RESULTS All treatments were found to improve quality of life for vitiligo patients .
Disease-altering interventions that were effective in repigmentation arrest of disease progression were also effective in improving quality of life .
Lifestyle-altering interventions were found to be selectively effective for patients with more severe quality of life impairment and Subscale analysis showed particular effectiveness of interventions in improving the emotional dimension of quality of life .
CONCLUSION Current interventions for vitiligo are effective in bettering the quality of life either by improving physical appearance of the patient or by addressing the psychological distress directly .
Less effectiveness was achieved for the functional and social dimensions , which are more dependent on social and cultural norms .
This suggests that current interventions alone are inadequate to address the holistic quality of life challenges associated with vitiligo .