Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment

Abstract

Photodynamic therapy has been described as an effective therapeutic option in selected cases of anogenital lichen sclerosus that are refractory to first-line treatments. However, procedure-related pain is a limiting factor in patient adherence to treatment. The authors report the case of a 75-year-old woman with highly symptomatic vulvar lichen sclerosus, successfully treated with photodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. This ready-to-use gas mixture may be a well-tolerated and accepted alternative to classical anesthetics in Photodynamic therapy, facilitating patients' adherence to illumination of pain-prone areas.

Photodynamic therapy: A hot topic in dermato-oncology (Review)

“…ALA-PDT with green light was also used in 11 patients with vulvar LS associated with severe itching. The authors reported significant improvement in local status, reduction of pruritus and good treatment tolerance, none of the patients requiring treatment cessation or topical analgesics (112).…”

“…Considering that procedure-related pain is an important adverse effect which limits the patients' adherence to treatment (111), some authors aimed their research at finding alternatives in order to decrease pain and avoid treatment discontinuation (112,113). Cabete et al reported good pain control after using inhaled nitrous oxide/oxygen gas mixture during MAL-PDT for vulvar LS.…”