Fractional CO₂ laser treatment as adjunctive therapy to topical steroids for managing vulvar lichen sclerosus

Abstract

Objectives: Uncontrolled vulvar lichen sclerosus (VLS) is often associated with distressful symptoms of genital itch, irritation, and pain and can lead to a pathological process including anatomical changes, scarring, and an elevated risk of cancer in the genital area. First-line topical corticosteroid as monotherapy is frequently not adequate to fully suppress disease activity and control symptoms. This study evaluated the efficacy of fractional CO 2 laser treatments as adjunctive therapy where recalcitrant VLS had been improved, but not adequately controlled, with topical corticosteroid treatment. Outcomes were evaluated up to 12 months after a series of CO 2 laser treatments delivered via a fractional handpiece. Materials and Methods: Women with a diagnosis of VLS supported by histologic findings on biopsy and/or clinical signs on physical examination received up to five monthly laser treatments. Subjects maintained existing topical corticosteroid and any exogenous hormone treatment during the study. Investigators assessed severity (0 = not present, 1 = mild, 2 = moderate, or 3 = severe) of clinical signs and architectural changes present before adjunctive study interventions and at followup visits. Subjects reported the presence of clinical symptoms and impact on quality of life on 4-or 5-point Likert scales. The validated Female Sexual Function Index (FSFI) was used to assess changes in sexual function. Four subjects were biopsied before adjunctive laser treatment and at follow-up. Results: Twelve females, 11 postmenopausal, with a mean age of 57 ± 10 years received three to five monthly CO 2 laser treatments. Significant improvement in all prominent clinical signs and architectural changes were reported at the 3-and 6-month follow-ups after the treatment series. Significant improvement was maintained at the 12-month follow-up, with 89% of subjects showing at least onepoint improvement in elasticity compared to baseline; 86% in lichenification; 88% in sclerosis; and 80% in whitening and parchment-like skin. Labial fusion and the extent of disease improved in 50% of patients. Ulcerations present in three subjects at baseline resolved after treatment. Subjects reported 86% improvement in dyspareunia and 83% in skin tearing. Quality of life improved significantly after treatment (p < 0.01). The 6-month follow-up FSFI showed significant improvement in sexual function compared to baseline (p < 0.05), with a mean point improvement of 4.5. Histology findings after treatment showed some positive improvement, as a decrease in dermal hyalinized zone thickness. There were no treatment complications or adverse events related to the treatment. Conclusions: Fractional CO 2 laser treatment outcomes showed improvement in predominant clinical signs and architectural changes in VLS recalcitrant to topical corticosteroid treatment. Adjunctive laser treatment relieved symptoms and

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 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 3–6); 15 RCT, 23–37 87 cohort studies, 38–124 eight case reports, 125–132 one case‐control study, 133 including a total of 9000 women, not accounting for overlap between the studies. Additionally, three cross‐sectional studies focused solely on the characteristics of AEs 134–136 .…”

“…Of the included studies, 81 studies investigated CO 2 ‐LASER from different manufacturers 23–31,33,35,36,38–58,66–93,95–104,122–125,128–131,133,136 . Twenty‐eight studies investigated Er:YAG LASER from different manufacturers 32,34,59–65,94,107–121,127,132,135 .…”

“…In this review, 99 studies including 51 094 patients provided no information on severe adverse events (SAE) related to using LASER as a vaginal or vulvar treatment 23–42,44,45,47–50,52–70,72–78,80–85,87–92,94–106,108,110–124,128–131,133,135 . Eleven studies gave no information on SAE or AEs 43,46,51,71,79,86,93,107,109,126,132 .…”

Extragenital Bullous Lichen Sclerosus Treated with Fractional CO2 Laser (FxCO2) and Wet Dressing of Halcinonide Solution: A Case Report

“…It has been reported in the literature that FxCO 2 therapy may be a sure remedy for patients with genital LS. 6–8 …”

Introduction to 2022 special dermatology/plastic surgery issue

“…Christensen et al 9 investigate the cutaneous pharmacokinetics and biodistribution patterns of the topical delivery of the PD-1 inhibitor nivolumab with laser-assisted passive diffusion and active intradermal injection in a porcine model. Stewart et al 10 evaluate the efficacy of fractional CO 2 laser treatments as adjunctive therapy for recalcitrant vulvar lichen sclerosis inadequately controlled by topical steroid therapy alone. Fredman et al 11 contribute a follow-up study with longer-term evaluation of tumor clearance, safety, and cosmesis after treatment of low-risk basal cell carcinoma (BCC) with enhanced uptake of the chemotherapeutic agents cisplatin and 5-fluorouracil after ablative fractional laser resurfacing.…”