Use of Er:YAG laser in the treatment of vulvar lichen sclerosus

Abstract

ObjectiveThe aim of this research was to evaluate the efficacy and safety of Er:YAG lasers to improve signs and symptoms of vulvar lichen sclerosus.MethodsThe study population consisted of 28 women with symptomatic vulvar lichen sclerosus. Three nonablative, thermal-only Er:YAG laser treatment sessions (7 J/cm2, 2 Hz, 7 mm spot) were performed at 4-week intervals. Each patient was asked about the presence of symptoms, such as itching, pain, and coital pain. Clinical diagnosis was established on the basis of the presence of lesions such as hypopigmentation, ecchymosis, hyperkeratosis, excoriations, or fissures. The affected areas were divided by zones (clitoris, introitus, labia minora, labia majora, perineum, labial fusion, and effacement) and were visually evaluated. Based on the presence of symptoms, lesions, and affected zones, a scale with a maximum of 14 scores was established for use before and after treatment. The impact of lichen sclerosus on patients' lives before and after treatment was evaluated with an 11-point visual analogue scale, and treatment discomfort was assessed at each session.ResultsAfter analysis of each scoring component, individual statistically significant reductions were observed in itching, pain, ecchymosis, excoriations, and hypopigmentation.ConclusionThe Er:YAG laser is a safe, well tolerated, and effective method for the adjuvant treatment of vulvar lichen sclerosus. Three sessions with monthly intervals using the indicated parameters can quantifiably reduce the impact of lichen sclerosus on patients' lives.

Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base

“…There were some clinical improvements observed including: visible improvement in skin colour, elasticity and vascularity, reduced elasticity, atrophy and fissures, 26 significant improvement of ecchymosis, excoriations and hypopigmentation 27 and improved whitening, elasticity and lichenification, although moderate to severe labial fusion improved in only four of the 11 subjects 28 . Symptoms that were reported to improve include itching, 23–25,27,29,30 vulvar discomfort, pain or soreness, 23,24,27 dryness, burning, bleeding, easy tears and ulcerated lesions 24 . Quality of life was reported to improve in two studies 27,28 and some patients stated improved sexual function 25,26,28–30 although skin tearing worsened in 50% (3/6) in one study 28…”

Laser Therapy for Recalcitrant Vulvar Lichen Sclerosus: A Review of the Literature

“…1,18 Ablative (removes epidermis and heats underlying dermis) and nonablative (heats up underlying dermis with protection of epidermis) ER:YAG lasers have shown benefit. [15][16][17] Ablative ER:YAG laser typically emits light with a wavelength of 2940 nm, which approximates the maximum absorption peak of water (3000 nm), allowing for more efficient tissue vaporization. [15][16][17] The ER:YAG laser provides rapid sequences of ultra-short pulses of 200 to 350 μs with intervals of 50 ms and temperatures of 60 to 65°C creating a superficial ablation with less thermal damage.…”

“…[15][16][17] The ER:YAG laser provides rapid sequences of ultra-short pulses of 200 to 350 μs with intervals of 50 ms and temperatures of 60 to 65°C creating a superficial ablation with less thermal damage. [15][16][17] Collagen is denatured, creating short collagen fibers that function as a stimulus of fibroblasts leading to neocollagenesis. [15][16][17]…”

“…[15][16][17] Collagen is denatured, creating short collagen fibers that function as a stimulus of fibroblasts leading to neocollagenesis. [15][16][17]…”

“…Energy-based therapies for systemic and vulvar LS include photodynamic therapy, high-intensity focused ultrasound, fractional carbon dioxide (FxCO2) and erbium YAG (Er:YAG) laser 1,7,11–17. Photodynamic therapy, largely used for extragenital LS and other challenging skin diseases utilizes UV light combined with gas or dye-based laser therapy, has shown benefit for vulvar disease 11–14.…”