***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 Vitiligo is a common hypopigmentation disorder with significant psychological impact if occurring before adulthood . A pilot clinical trial to determine the feasibility of an RCT was conducted and is reported here . Methods 12 participants 12 to 35 years old were recruited to a prospect i ve open-label pilot trial and treated with 60 mg of st and ardized G. biloba two times per day for 12 weeks . The criteria for feasibility included successful recruitment , 75 % or greater retention , effectiveness and lack of serious adverse reactions . Effectiveness was assessed using the Vitiligo Area Scoring Index ( VASI ) and the Vitiligo European Task Force ( VETF ) , which are vali date d outcome measures evaluating the area and intensity of depigmentation of vitiligo lesions . Other outcomes included photographs and adverse reactions . Safety was assessed by serum coagulation factors ( platelets , PTT , INR ) at baseline and week 12 . Results After 2 months of recruitment , the eligible upper age limit was raised from 18 to 35 years of age in order to facilitate recruitment of the required sample size . Eleven participants completed the trial with 85 % or greater adherence to the protocol . The total VASI score improved by 0.5 ( P = 0.021 ) from 5.0 to 4.5 , range of scale 0 ( no depigmentation ) to 100 ( completely depigmented ) . The progression of vitiligo stopped in all participants ; the total VASI indicated an average repigmentation of vitiligo lesions of 15 % . VETF total vitiligo lesion area decreased 0.4 % ( P = 0.102 ) from 5.9 to 5.6 from baseline to week 12 . VETF staging score improved by 0.7 ( P = 0.101 ) from 6.6 to 5.8 , and the VETF spreading score improved by 3.9 ( P < 0.001 ) ) from 2.7 to -1.2 . There were no statistically significant changes in platelet count , PTT , or INR . Conclusions The criteria for feasibility were met after increasing the maximum age limit of the successful recruitment criterion ; participant retention , safety and effectiveness criteria were also met . Ingestion of 60 mg of Ginkgo biloba BID was associated with a significant improvement in total VASI vitiligo measures and VETF spread , and a trend towards improvement on VETF measures of vitiligo lesion area and staging . Larger , r and omized double-blind clinical studies are warranted and appear feasible . Trial Registration Clinical trials.gov registration number Objective : Pseudocatalase/superoxide dismutase ( PSD ) is a topical gel considered having therapeutic effects in vitiligo . This study was design ed to evaluate the efficacy of this combination in vitiligo . Methods : This was a pilot r and omized , double-blind , placebo-controlled trial on 46 symmetrical vitiligo lesions of limbs in 23 patients referring to dermatology clinics , Isfahan , Iran in 2010 . Patients were received this formula or placebo gels for the right and left lesions . Lesion area and degree of pigmentation were assessed at baseline , 2 , 4 , and 6 months . Findings : There were no significant changes in lesion area and perifollicular pigmentation in each group ( P > 0.05 ) . Conclusion : The results indicated no significant therapeutic effect for PSD in vitiligo Summary For effective treatment of vitiligo , it is as important to arrest the progression of the disease as it is to induce repigmentation . Recently , oxidative stress has been shown to play an important role in the pathogenesis of vitiligo . Ginkgo biloba extract has been shown to have antioxidant and immunomodulatory properties . In a double‐blind placebo‐controlled trial , we evaluated the efficacy of G. biloba extract in controlling the activity of the disease process in patients with limited and slow‐spreading vitiligo and in inducing repigmentation of vitiliginous areas . Fifty‐two patients were assigned to two treatment groups ( A and B ) in a double‐blind fashion , but only 47 patients could be evaluated , because one patient in group A and four patients in group B withdrew for reasons unrelated to the study . Patients in group A were given G. biloba extract 40 mg three times daily whereas patients in group B received placebo in similar doses . A statistically significant cessation of active progression of depigmentation was noted in patients treated with G. biloba ( P = 0.006 ) . Marked to complete repigmentation was seen in 10 patients in group A , whereas only two patients in group B showed similar repigmentation . The G. biloba extract was well tolerated . G. biloba extract seems to be a simple , safe and fairly effective therapy for arresting the progression of the disease Narrow-b and UVB has been reported to be efficacious in patients with vitiligo . The epidermis of patients with vitiligo showed reduction in the levels of catalase , in association with high levels of hydrogen peroxidase ( H2O2 ) that is toxic for melanocytes . Based on these findings , we studied the efficacy and safety of a topical gel containing catalase and superoxide dismutase ( Vitix ) in combination with narrow-b and UVB . The study included 22 patients of which 19 completed the 6-month study period . Patients applied the gel containing catalase and superoxide dismutase twice a day and received narrow-b and UVB 3 times per week . Two different dermatologists evaluated the grade of repigmentation by photograph comparison . At the end of therapy , more than 50 % of overall repigmentation was noticed in 11 of 19 ( 57.9 % ) patients . More than 75 % repigmentation was recorded in three ( 15.79 % ) , 26%-50 % repigmentation in six ( 31.58 % ) patients and 1%-25 % repigmentation in one ( 5.26 % ) patient , whereas one ( 5.26 % ) of 19 patients showed no repigmentation at all . The best response was achieved on the face and neck , with more than 50 % repigmentation observed in 11 of 14 ( 78.6 % ) patients . Development of new lesions was not observed . Adverse events were mild and transient . The study showed that the combination therapy of narrow-b and UVB and gel containing catalase and dismutase is a therapeutic option that could be considered in the management of vitiligo . Further evaluation of this combination in multicenter , double-blind , placebo-controlled studies should be undertaken Background : Generalized vitiligo is a disease with unpredictable bursts of activity , goal of treatment during the active phase being to stabilize the lesions . This emphasizes the need for a prospect i ve marker for monitoring disease activity to help decide the duration of therapy . Aims and Objectives : In the present study , we examined whether reactive oxygen species ( ROS ) generated in erythrocytes can be translated into a marker of activity in vitiligo . Material s and Methods : Level of intracellular ROS was measured flow cytometrically in erythrocytes from venous blood of 21 patients with generalized vitiligo and 21 healthy volunteers using the probe dichlorodihydrofluorescein diacetate . Results : The levels of ROS differed significantly between patients and healthy controls , as well as between active versus stable disease groups . In the active disease group , ROS levels were significantly lower in those being treated with systemic steroids than those that were not . ROS levels poorly correlated with disease duration or body surface area involved . Conclusion : A long-term study based on these findings can be conducted to further vali date the potential role of ROS in monitoring disease activity vitiligo Narrow b and UVB is succeeding psoralen and UVA irradiation as the main treatment of vitiligo vulgaris in several European countries . Vitamin B12 and folic acid deficiency in some vitiligo patients has prompted research ers to investigate the efficacy of these vitamins in the treatment of vitiligo . In the present controlled study we investigated the value of narrow b and UVB phototherapy in the treatment of vitiligo and the possible additive effect of vitamin B12 and folic acid .  Twenty-seven patients with long-term stable vitiligo were included and r and omized in a  " UVB only " ( UVB ) or " UVB combined with vitamin B12 and folic acid " ( UVB+ ) group . Patients were irradiated thrice weekly for one year , whilst repigmentation was carefully monitored . In 92 % ( 25/27 ) of the patients up to 100 % repigmentation was seen . Repigmentation was notable in lesions on the face , neck and throat , lower arm , chest , back and lower legs , whilst repigmentation on the h and s , wrists , feet and ankles proved to be minimal . Maximum repigmentation rates did not differ significantly between the UVB group and the UVB+ group . Our study reconfirms that narrow b and UVB phototherapy is an effective treatment for vitiligo and shows that co-treatment with vitamin B12 and folic acid does not improve the outcome of treatment of vitiligo with narrow b and UVB phototherapy Phyllanthus emblica , vitamin E , and caroteinods are compounds showing antioxidative , anti-inflammatory , and repigmenting effects , whose role in vitiligo treatment has not been evaluated so far . Sixty-five subjects ( group A ) were treated with one tablet of an oral supplement containing P. emblica ( 100 mg ) , vitamin E ( 10 mg ) , and carotenoids ( 4.7 mg ) three times/day for 6 months and compared with a  control group ( group B , 65 patients ) , which instead was not treated with antioxidants . Both groups were simultaneously treated with a comparable topical therapy and /or phototherapy . After a 6 months follow-up , a significantly higher number of patients in group A had a mild repigmentation on the head/neck regions ( p = 0.019 ) and on the trunk ( trend , p = 0.051 ) . The number of patients who presented no repigmentation in head/neck , trunk , upper , and lower limbs was significantly higher in group B ( respectively , p = 0.009 , p = 0.001 , p = 0.001 , p = 0.025 ) . Moreover , group B patients showed higher signs of inflammation ( p = 0.002 ) , a more rapid growth of the lesions ( p = 0.039 ) , a higher percentage of worsening disease ( p = 0.003 ) , and more erythema ( p = 0.059 ) , whereas group A patients showed a higher percentage of steady disease ( p = 0.065 ) . Our results suggest that the supplement with antioxidants in patients with vitiligo might represent a valuable instrument to increase the effectiveness of other vitiligo treatments . [ Correction added after online publication 06-Oct-2014 : the dosages of vitamin E and carotenoids have been up date d. ] Background : Vitiligo is an acquired idiopathic cutaneous disease characterized by pearly white patches of variable shapes and sizes . Various medical and surgical therapeutic options have been proposed to achieve repigmentation ; phototherapy is one of the most efficient options . Topical therapies have been a mainstay of vitiligo treatment , with or without phototherapy . Aim of the work : To compare the efficacy of combined topical antioxidant hydrogel and excimer light versus excimer light alone in treating vitiligo . Patients and Methods : Thirty patients were included in this comparative , prospect i ve , r and omized study . For each patient , at least 2–4 vitiliginous macules were r and omly selected and treated while an untreated vitiliginous macule served as control . Lesions were divided into two groups : Group A received combination therapy of daily topical antioxidant plus excimer light , while Group B received only excimer light . Lesions were treated twice a week for a maximum of 24 sessions . Initial fluencies were adjusted individually according to the minimal erythema dose in vitiliginous skin . Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians . Results : Group A lesions showed significant efficacy than group B ( p < 0.001 ) , specially on treating UV-sensitive lesions with no side effects . Conclusion : Topical antioxidant and excimer light represents a valuable , effective therapy for localized vitiligo BACKGROUND Among all the topical immunomodulators , vitiligo 's mainstay therapy includes topical corticosteroids . Many other non-immune theories have also been suggested for vitiligo 's pathogenesis , but the role of oxidative stress has gained more importance in recent years . OBJECTIVE To compare the effect of topical 0.05 % betamethasone vs. catalase/dismutase superoxide ( C/DSO ) . STUDY DESIGN R and omized , matched-paired , double-blind trial . SETTING Dermatology Section , University of Antioquia , Medellín , Colombia . SUBJECTS Patients ( aged > 18 years or between 12 and 18 years ) with parent 's informed consent , with stable or active bilateral vitiligo . INTERVENTION Topical 0.05 % betamethasone or C/DSO . METHODS Two lesions similar to each other in size were chosen . All assessment s were made by two blinded investigators , and photographs were subjected to morphometry analysis . MAIN OUTCOME Skin repigmentation by digital morphometry . RESULTS Twenty-five patients were enrolled in the study ( 21 women and 4 men ) . Mean age of participants was 40 years ( range : 12 - 74 years ) . One patient on C/DSO experienced a mild local erythematous papular rash that self-resolved . 
    Output:
    
RESULTS A deregulated oxidative pathway is clearly evident with elevated superoxide dismutase , decreased catalase and increased lipid peroxidation .
However , similar results have been obtained in other inflammatory skin diseases such as psoriasis , atopic dermatitis , lichen planus and urticaria .
Some isolated successes have been reported with oral ginkgo biloba , polypodium leucotomos and vitamin C and E preparations , while other clinical trials have failed to show reproducible results .
The use of topical antioxidants delivers in general no beneficial results .
The oxidative pathway is affected in vitiligo , but its unique initiating or contributory role in the pathogenesis is less evident .