Short‐ and long‐term efficacy of focused ultrasound therapy for non‐neoplastic epithelial disorders of the vulva

Abstract

Objective To investigate the short-and long-term efficacy and influential factors of focused ultrasound for the treatment of nonneoplastic epithelial disorders of the vulva (NNEDV).Design A retrospective observational study.Setting A gynaecologic department in a single centre in China.Population Patients with NNEDV were included in this study: 85 patients were diagnosed with lichen simplex chronicus (LSC), 44 patients with vulva lichen sclerosus (VLS), and seven patients with lichen planus (LP).Methods A total of 136 eligible patients with NNEDV were treated with focused ultrasound. After the treatment, based on changes in the degree of symptom severity and local skin signs (lesion size, skin colour and elasticity) before and after treatment, the treatment effectiveness for each patient was assessed. We further analysed the relations among pathologic type, age, course and curative rate. Statistical analysis was performed using the Chisquare (McNemar) test.Main outcome measures Improvement in the symptoms and physical signs and the predictive factors.Results Symptom relief was observed in all patients. The appearance and colour of the vulva returned to normal after the ultrasound treatment. Complete remission (CR) occurred in 68 of 136 (50%) patients (41 patients with LSC and 12 patients with VLS). The response rate was 93.38% (127/136). Seven patients who had a poor response to the first session of treatment were treated again with ultrasound therapy and a good response was observed. No severe complications were observed. There was no significant difference in treatment results among the different pathological types (P > 0.05). However, the course of the disease and the age of the patients were related to the treatment results (P < 0.05).Conclusions NNEDV can be treated with focused ultrasound effectively and safely. The course of the disease and the age of the patients may be predictive factors.Keywords Focused ultrasound, non-neoplastic epithelial disorders of the vulva efficacy, related factors.Tweetable abstract Patients with non-neoplastic epithelial disorders of the vulva can be safely and effectively treated with focused ultrasound. No significant difference in treatment results was observed between the different types of non-neoplastic epithelial disorders of the vulva.

Update on treatments for erosive vulvovaginal lichen planus

“…High‐intensity focused ultrasound involves the delivery of high‐frequency/high‐power ultrasound waves to affected areas while under general anesthesia. One study reported that four of seven patients had complete disease remission as far as 5 years out from treatment, and all seven patients had at least moderate clinical and symptomatic improvement . The specifics of the timeframe were not reported; however, all patients were followed for at least 12 months.…”

“…(Step 3) Methotrexate and mycophenolate mofetil have been shown to be effective; however, other options such as hydroxychloroquine, acitretin, and cyclosporine exist. (Step 4) Patients still not responding may benefit from a procedural intervention such as photodynamic therapy or focused ultrasound therapy…”

Therapeutic Assessment of High-Intensity Focused Ultrasound for Vulvar Lichen Sclerosus by Active Dynamic Thermal Imaging and Hyperspectral Imaging—A Preliminary Study

“…Considering the serious side effects of traditional treatment, high-intensity focused ultrasound (HIFU) treatment, which uses ultrasound as a carrier of energy, has gradually gained popularity as an alternative treatment for VLS [2,4,[12][13][14][15][16]. Propagating harmlessly, HIFU causes a sufficient local rise in temperature for the thermal destruction of target tissues without damaging surrounding or overlying tissues [17].…”

“…Furthermore, HIFU has been used for several other therapeutic applications [13,19]. Recently, several clinical trials have shown that HIFU treatment could relieve itching of the vulva and recover the vulvar skin's elasticity and appearance [12][13][14][15][16]. HIFU appears to be a promising treatment modality for vulvar diseases, including VLS.…”

“…In clinical settings, patient symptoms, including pruritus and skin appearance, were investigated by a questionnaire before and after the treatment [20][21][22]. The scores on the questionnaire were used to evaluate effectiveness [12,14], but these are subjective and may cause mis-assessment. Since this assessment method is based on symptoms, evaluation of therapeutic effectiveness cannot be carried out until at least 3 months after treatment, which is time-consuming and may lead to delayed re-treatment.…”