Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus

Burkett, Linda; Siddique, Moiuri; Zeymo, Alexander; Brunn, E.; Gutman, Robert E.; Park, Amy J.; Iglesia, Cheryl B.

doi:10.1097/aog.0000000000004332

Cited by 20 publications

(47 citation statements)

References 26 publications

(41 reference statements)

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“…A total of 114 papers were included according to the eligibility criteria listed above. Of these, 111 studies investigated GSM, VVA, UI, and LS symptoms as primary indication (Tables 3 , 4 , 5 , 6 ); 15 RCT, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 87 cohort studies, 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ,…”

Section: Resultsmentioning

confidence: 99%

“…Of the included studies, 81 studies investigated CO 2 ‐LASER from different manufacturers. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ,…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies examining the effect of vulvar LASER on LS were identified (Table 6 ). 35 , 36 , 37 , 122 , 123 , 124 , 128 , 129 , 130 , 131 , 132 The studies include 263 women with study sizes ranging from two to 52 women with a median (IQR) of 20 (7.5–40) women. Among these studies, nine studies investigated the effect of CO 2 LASER, 35 , 36 , 122 , 123 , 124 , 128 , 129 , 130 , 131 counting two RCTs including 92 women 35 , 36 and three cohort studies including 92 women.…”

Section: Resultsmentioning

confidence: 99%

“… 35 , 36 , 37 , 122 , 123 , 124 , 128 , 129 , 130 , 131 , 132 The studies include 263 women with study sizes ranging from two to 52 women with a median (IQR) of 20 (7.5–40) women. Among these studies, nine studies investigated the effect of CO 2 LASER, 35 , 36 , 122 , 123 , 124 , 128 , 129 , 130 , 131 counting two RCTs including 92 women 35 , 36 and three cohort studies including 92 women. 122 , 123 , 124 One study investigated the effect of Er:YAG 32 and one RCT with 38 women investigated the effect of Nd:YAG.…”

Section: Resultsmentioning

confidence: 99%

“… 36 Two RCTs consisting of 90 women comparing respectively CO 2 and Nd:YAG with steroid treatment reported significant between‐group and in‐group improvement favoring the LASER groups. 35 , 37 Women in RCTs were followed for a maximum of 6 months after the last session. 35 , 36 , 37 …”

Section: Resultsmentioning

confidence: 99%

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The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

Mortensen

Christensen

Løkkegaard

2022

Acta Obstet Gynecol Scand

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In recent years, LASER has been introduced as a minimally invasive treatment for a broad range of vaginal and vulvar symptoms and diseases. However, the efficacy and safety of vaginal and vulvar LASER has continuously been questioned. The aim of this study is to create an overview of the current literature and discuss the controversies within the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus. A search string was built in PubMed.The search was commenced on August 25, 2021 and closed on October 27, 2021. Two authors screened the studies in Covidence for inclusion according to the eligibility criteria in the protocol. The data were extracted from the studies and are reported inThe authors set up an internal protocol to use as a guideline for the review, listing the criteria and outcomes for this review. The eligibility criteria for this state-of-the-art review adhered to the principals of PICO-participants, interventions, comparison and outcome. Studies that investigated the effect of any vaginal and vulvar LASER on women with symptoms of GSM, VVA, UI or LS were eligible for inclusion. No outcome restrictions were applied.Only original studies were included; unpublished work, editorials, conference abstracts, reviews and meta-analysis were excluded.Likewise, in vivo studies on animals, histologic cohort studies, and studies of the effect of radiofrequency treatment were excluded.indications as a treatment should be kept on a research level until further high-quality evidence is available.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

Mortensen

Christensen

Løkkegaard

2022

Acta Obstet Gynecol Scand

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A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO₂ laser therapy

et al. 2023

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Objectives: To investigate the histologic characteristics of vulvar tissues before and after completion of fractionated carbon dioxide (CO 2 ) laser therapy (FxCO2) for vulvar lichen sclerosus (LS). The secondary objective was to assess subjective improvement in symptoms via the Skindex-16 questionnaire. Methods: This prospective single-arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten postmenopausal women with biopsy-proven LS planning FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, topical corticosteroid use within 8 weeks, prior pelvic radiation, malignancy, active genital infection, or pregnancy. The vulvovaginal SmartXide2-V2-LR laser system fractionated CO 2 laser (DEKA) was utilized to treat visually affected areas of vulvar and perianal LS with a single pass. Subjects underwent three treatments 4-6 weeks apart. Subjects completed the Skindex-16 questionnaire and had vulvar biopsy at baseline and at 4 weeks after completion of fractionated CO 2 laser therapy. Blinded histologic slides were scored by one dermatopathologist (Michael A. Cardis) rating from 1 to 5 the degree of dermal sclerosis, inflammation, and epidermal atrophy. Change scores were calculated as the difference between preand post-treatment scores for each subject. Results: The 10 subjects enrolled had a mean age of 61 and most were white, privately insured, and had a college/graduate-level education. Post-fractionated CO 2 laser treatment vulvar biopsies showed significant improvement in sclerosis and epidermal atrophy compared with pretreatment baseline biopsy specimens (p < 0.05) with no statistically significant change found in inflammation score. Skindex-16 and FSFI scores showed a trend towards improvement (p > 0.05 for both). A statistically significant correlation was found between change in sclerosis and Skindex-16 symptoms scores with an average change of 21.4 units in Skindex-16 symptoms score for every one-point change in histologic sclerosis score (p = 0.03). Conclusions: In postmenopausal women with vulvar LS undergoing fractionated CO 2 laser, symptomatic improvements correlated with histologic change in degree of sclerosis on vulvar biopsy. These results demonstrate FxCO2 laser therapy as a promising option for the treatment of LS and suggest that further studies should assess degree of sclerosis on histopathology.

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A systematic review of outcome measures evaluating treatment efficacy in vulval lichen sclerosus and evaluation of patients' priorities

Jasionowska,

Almadori,

Goble

et al. 2024

Skin Health and Disease

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Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by itching, apareunia, loss of vulval architecture and scarring. Heterogeneity in outcome reporting precludes comparison between treatments. This study aimed to systematically review outcome measures used to evaluate the efficacy of VLS treatments and present patients' treatment priorities. This review followed the PRISMA guidelines using a registered protocol (PROSPERO: CRD42022356738). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials and International Standard Randomised controlled trial (RCT) registries. All RCTs assessing any treatment for VLS were eligible for inclusion. A total of 775 patients were assessed across 21 RCTs. The assessment tools reported outcomes in the following domains: patient‐reported symptoms assessed with one validated scale in 12 studies and seven non‐validated scales in nine studies; sexual function with validated female sexual function index and female sexual distress scale in two studies and two non‐validated scales in two studies; quality of life with three validated scales in three studies and clinician‐reported objective outcomes with two validated scales in three studies and six non‐validated scales in fourteen studies. Histological changes were assessed in 10 studies and tissue biomechanics in one study. We also carried out an online survey completed by 809 women with VLS to assess their research and disease treatment priorities and identified validated outcome measures to assess these. There is high variability in assessing treatment outcomes for VLS. We identified validated assessment tools which could be implemented in VLS studies to evaluate the effectiveness of treatments.

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Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 20 publications

References 26 publications

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO₂ laser therapy

A systematic review of outcome measures evaluating treatment efficacy in vulval lichen sclerosus and evaluation of patients' priorities

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Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 20 publications

References 26 publications

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy

A systematic review of outcome measures evaluating treatment efficacy in vulval lichen sclerosus and evaluation of patients' priorities

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A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO₂ laser therapy