***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: The present study was design ed to evaluate the effect of combining fractional CO2 laser with narrow-b and ultraviolet B ( NB-UVB ) versus NB-UVB in the treatment of non-segmental vitiligo . The study included 20 patients with non-segmental stable vitiligo . They were divided into two groups . Group I received a single session of fractional CO2 laser therapy on the right side of the body followed by NB-UVB phototherapy twice per week for 8 weeks . Group II received a second session of fractional CO2 laser therapy after 4 weeks from starting treatment with NB-UVB . The vitiligo lesions were assessed before treatment and after 8 weeks of treatment by VASI . At the end of the study period , the vitiligo area score index ( VASI ) in group I decreased insignificantly on both the right ( −2.6 % ) and left ( −16.4 % ) sides . In group II , VASI increased insignificantly on the right ( + 14.4 % ) and left ( + 2.5 % ) sides . Using Adobe Photoshop CS6 extended program to measure the area of vitiligo lesions , group I showed a decrease of −1.02 and −6.12 % in the mean area percentage change of vitiligo lesions on the right and left sides , respectively . In group II the change was + 9.84 and + 9.13 % on the right and left sides , respectively . In conclusion , combining fractional CO2 laser with NB-UVB for the treatment of non-segmental vitiligo did not show any significant advantage over treatment with NB-UVB alone . Further study of this combination for longer duration s in the treatment of vitiligo is recommended Resistant non-segmental vitiligo is difficult to be treated . Ablative erbium-YAG ( Er : YAG ) laser has been used in the treatment of vitiligo , but the ablation of entire epidermis frustrated the compliance of patients . The purpose of this study is to investigate the effects of fractional Er : YAG laser followed by topical betamethasone and narrow b and ultraviolet B ( NB-UVB ) therapy in the treatment of resistant non-segmental vitiligo . The vitiligo lesions of each enrolled patient were divided into four treatment parts , which were all irradiated with NB-UVB . Three parts were , respectively , treated with low , medium , or high energy of Er : YAG laser , followed by topical betamethasone solution application . A control part was spared with laser treatment and topical betamethasone . The treatment period lasted 6 months . The efficacy was assessed by two blinded dermatologists . Treatment protocol with high energy of 1800 mJ/P of fractional Er : YAG laser followed by topical betamethasone solution and in combination with NB-UVB made 60 % patients achieve marked to excellent improvement in white patches . The protocol with medium energy of 1200 mJ/P of laser assisted approximate 36 % patients achieve such improvement . The two protocol s , respectively , showed better efficacies than NB-UVB only protocol . However , fractional Er : YAG laser at low energy of 600 mJ/P did not provide such contributions to the treatment of vitiligo . The fractional Er : YAG laser in combination with topical betamethasone solution and NB-UVB was suitable for resistant non-segmental vitiligo . The energy of laser was preferred to be set at relatively high level BACKGROUND Vitiligo is a pigmentary disorder of skin affecting at least 1 % of the world population of all races in both sexes . Its importance is mainly due to subsequent social and psychological problems rather than clinical complications . Various treatment choices are available for vitiligo ; however , laser-based courses have shown to give more acceptable results . OBJECTIVE The aim of this trial was to evaluate the efficacy of Er : YAG laser as a supplementary medicine to topical 5FU and clobetasol in vitiligo patients . METHODS Two comparable vitiligo patches from 38 eligible patients were r and omized to receive topical 5FU and clobetasol in control group and additional Er : YAG laser in intervention group . Major outcomes of interest were the size of patch and pigmentation score at r and omization and 2 and 4 months after therapy . RESULTS Final sample included 18 ( 47 % ) male patients and age of 35.66±8.04 . The performance Er : YAG group was superior in all sites . Reduction in the size of patches was greater in Er : YAG group ( p-value=.004 ) . Also , this group showed a higher pigmentation scores in the trial period than control group ( p-value<.001 ) . CONCLUSIONS Greater reduction in the size and increase in pigmentation score was seen in Er : YAG group especially for short periods after therapy and repeating laser sessions may help improving final outcomes . Er : AYG could help in reducing complications of long-term topical treatments , achieving faster response , and improving patient adherence Facial vitiligo is associated with considerable psychological impact . The management is challenging and requires multidisciplinary treatment . Adding fractional carbon dioxide ( CO2 ) to the conventional treatment has been reported as an effective modality . This study aim ed to evaluate the efficacy of combined fractional CO2 laser , targeted ultraviolet B ( UVB ) phototherapy , and topical steroid on facial vitiligo . A prospect i ve , r and omized , split face study was conducted on 14 patients with symmetrical non-segmental facial vitiligo . Ten sessions of fractional CO2 laser was performed on the lesions on one side of face with 2-week interval . Immediately after laser , the lesions on both side of face were treated with 10 sessions of 2-week interval targeted UVB phototherapy and twice daily application of topical 0.05 % clobetasol propionate cream . The patients were followed up for 12 weeks after the last treatment . Clinical improvement was grade d by blinded dermatologists and patients using a quartile grading scale . Twelve out of 14 patients completed the study . The degree of improvement was not different between both sides in nine patients . One patient showed more improvement on the combined laser side , and two patients showed inferior results on the combined laser side . Two patients with lesser improvement on the laser-treated side had positive Koebner phenomenon on the non-facial area . The combined treatment with laser , targeted UVB , and topical steroids are not superior to targeted UVB and topical steroids in facial vitiligo . Furthermore , laser may retard the response to the st and ard treatment in patients with Koebner phenomenon on non-treated areas Despite the multiple treatment modalities available for vitiligo , none of them gives satisfactory results in the periungual type . In this study we tried to explore and evaluate the effects of the combination treatment of erbium : YAG laser resurfacing and topical 5-flurouracil in periungual vitiligo . Nine adult patients presenting with periungual vitiligo lesions were included in this prospect i ve left-right comparative study . The desirable inflammation was achieved after a mean of 4.7 days of 5-flurouracil application . The mean re-epithelization time in the treatment sessions was 11.3 days . The patients received a mean of 3.4 sessions in a mean duration of 7.6 months . The mean overall response to therapy in the treated group was 47.8 % while in the control group it was 1.1 % ( P < 0.0001 ) . No side effects necessitated the stoppage of treatment . This study points to the efficacy and safety of this combination in the treatment of periungual vitiligo BACKGROUND Fractional CO2 laser and autologous hair transplantation are independently effective in the treatment of refractory and stable vitiligo . OBJECTIVE The authors ' purpose was to evaluate the therapeutic efficacy of fractional CO2 laser pretreatment compared with autologous hair transplantation and phototherapy alone for refractory and stable vitiligo . METHODS A total of 20 patients with refractory and stable vitiligo were enrolled from our clinic . Resistant lesions r and omly divided into 2 regions as follows : ( 1 ) Part A : fractional CO2 laser pretreatment followed by autologous transplantation and phototherapy , and ( 2 ) Part B : autologous transplantation and phototherapy alone . Five days after fractional CO2 laser application to Part A , both treatment regions received a transplant of scalp grafts . On Day 11 , the entire lesion was exposed to narrow-b and UVB phototherapy , twice a week for 12 weeks . The diameter of perifollicular repigmentation was measured monthly with a caliper . RESULTS Perifollicular repigmentation was detectable surrounding 74 % of grafted hair follicles by Month 3 . Furthermore , Part A demonstrated a significantly greater diameter of repigmentation with 6.6 ± 5.8 mm in Part A compared with 4.3 ± 1.8 mm in Part B ( p = < .001 ) . CONCLUSION In this study , our results demonstrate improved efficacy of autologous hair transplantation and narrow-b and UVB with fractional CO2 laser pretreatment in refractory and stable vitiligo OBJECTIVE To compare the efficacy and safety of using a combination of fluticasone propionate ( FP ) and UV-A with that of either drug used alone in the long-term treatment of vitiligo . DESIGN Prospect i ve , r and omized , controlled , left-right comparison study . Repigmentation was judged by a single dermatologist ( L.N.-K. ) and skin thickness was scored by a pathologist ( using biopsy sample s ) , a dermatologist ( L.N.-K. ) ( visually ) , and patients ( using a st and ard question naire ) . SETTING Netherl and s Institute for Pigmentary Disorders , Amsterdam . PATIENTS Patients with lesions on arms , legs , and trunk were treated on 2 symmetrical lesions for 9 months with FP alone and a combination of FP and UV-A ( FP group ) or with UV-A alone and a combination of FP and UV-A ( UV-A group ) . Fluticasone propionate cream was applied once daily at about bedtime , and UV-A ( 10 J/cm2 ) exposure was twice a week . Patients attended the clinic at 3-month intervals . RESULTS One hundred thirty-five patients were included , 96 of whom were evaluable after 9 months . Patients not reaching the end point withdrew because of insufficient repigmentation  ( n = 23 ) , decreased motivation  ( n = 11 ) , or protocol violations ( n = 5 ) . No patient ( irrespective of whether they withdrew ) experienced any adverse effects . The FP and UV-A groups were comparable with respect to sex , age , and location of lesions . On average , combination treatment was 3 times more effective than either UV-A or FP treatment alone . In the FP group , no atrophy was seen after 9 months with either treatment . In the UV-A group , a little atrophy was detected twice : as well during UV-A treatment alone as during combination treatment . CONCLUSIONS Combination treatment with FP and UV-A is much more effective in reaching complete repigmentation than are FP and UV-A used alone , but large inter-individual differences occur . Fluticasone propionate , UV-A , and a combination of FP and UV-A seem to be safe for long-term treatment of vitiligo BACKGROUND AND OBJECTIVE Conventional treatment of vitiligo on h and s and feet often produces an unsatisfactory result . Various ablative treatment methods were tried with favorable results in facial , neck , and truncal areas . The aim of this study is to evaluate the efficacy and safety of combined fractional CO2 laser , narrowb and UVB ( NB-UVB ) phototherapy , and topical clobetasol propionate in managing stable vitiligo in difficult-to-treat areas . STUDY DESIGN A prospect i ve r and omized-intraindividual study was conducted on 27 patients with 27 pair-lesions of non-segmental vitiligo on both h and s. The lesions were r and omized to receive treatment with fractional CO2 laser , NB-UVB phototherapy , and 0.05 % clobetasol propionate cream ( Group A ) or NB-UVB phototherapy and 0.05 % clobetasol propionate cream ( Group B ) . Fractional CO2 laser was performed at 1-week interval for 10 sessions . NB-UVB phototherapy was administered twice weekly for 20 sessions . Patients were evaluated 12 weeks after the last treatment . Outcome was evaluated objective ly based on st and ard digital photographs , patient satisfaction , and adverse events . RESULTS Twenty-six patients completed the study . Six vitiligious lesions ( 23.1 % ) in group A achieved good to excellent repigmentation compared with one lesion ( 3.9 % ) in group B ( P = 0.065 ) . The overall mean improvement score was 1.35 ( ± 1.38 ) in group A and 0.50 ( ± 0.95 ) in group B ( P = 0.0004 ) . Patients ' satisfaction score was significantly higher for the lesions in group A than group B. Lesions on the dorsum of the h and showed a higher response rate than those on the fingers . No serious side-effects were noted . CONCLUSION This study demonstrates that adding fractional CO2 laser treatment to NB-UVB phototherapy and topical steroids improves the repigmentation rate of vitiliginous lesions on h and s in some patients . This technique may be offered to vitiligo patients who are unresponsive to other treatments The aim of this study is to evaluate the use of fractional carbon dioxide laser ( CO2 ) with betamethasone and salicylic acid solution in the treatment of patients with refractory vitiligo in h and s. Each h and of the patient was r and omly assigned to one of 
    Output:
    
Subgroup analysis showed that the erbium laser group , CO2 laser group and fractional CO2 laser group achieved significantly better repigmentation than the control groups .
According to objective and subjective evaluations , treatments for vitiligo are more effective when combined with ablation therapy than when used alone