Treatment vulvar lichen sclerosus with fractional CO2-laser: cohort clinical study

• Inna A. Apolikhina
• Anna V. Sokolova
• Ivan S. Balashov
• Lyudmila V. Chernukha
• Elena I. Ermakova

Abstract

Aim - to determine effective treatment strategy for patients with vulvar lichen sclerosus.

Material and methods. The study included 42 women aged 26 to 68 years (average age was 50 years old), who were treated for vulvar lichen sclerosus in 2017-2019 with local glucocorticosteroid (0.05% clobetasol propionate), n=17 and fractional microablative CO₂ laser using a SMARTXIDE² V²LR, DEKA system (Italy), n=25. The inclusion criteria: age ≥21 years, morphologically confirmed diagnosis of vulvar lichen sclerosus, written consent to participate in the study. The results were evaluated over the period of 3 and 6 months after the end of treatment using the questionnaires visual analogue scale (VAS), the index of female sexual function (FISI), vaginal health index.

Results. Evaluation of the clinical efficacy of vulva treatment using fractional microablative CO₂ of the laser system (SMARTXIDE² V²LR, DEKA, Italy) 6 months after the treatment was as follows: 81% for dryness, 73% for burning, 70% for pain, 56% for itching and 55% for dyspareunia in external genitalia. Improvement of sexual function (desire, arousal, hydration, orgasm, satisfaction and pain) was only after laser application.

Conclusion. According to our research treatment of external genitalia pruritus is recommended to begin with the use of local corticosteroids. Symptoms of vulvar lichen sclerosus of less importance such us dryness and dyspareunia, were resistant to local glucocorticosteroid therapy (GCS) and had the best response when exposed to fractional microablative CO₂-laser with the following parameters 30 (Power) - 1000 (Dwell time) -1000 (Spacing) 1-3 (SmartStack).

Keywords:vulvar lichen sclerosus, treatment vulvar lichen sclerosus, fractional microablative CO2-laser, local glucocortico-steroids

References

1. Tran D.A., Tan X., Macri C.J., Goldstein A.T., Fu S.W. Lichen Scle-rosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci. 2019; 15 (7): 1429-39.

2. Stuart G.C., Nation J.G., Malliah V.S., Robertson D.I. Laser therapy of vulvar lichen sclerosus et atrophicus. Can J Surg. 1991; 34 (5): 469-70.

3. Preti, M., VieiraBaptista P., Digesu G.A., et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. Neurourol Urodyn. 2019; 38: 1009-23.

4. Bizjak Ogrinc U., Senear S., Luzar B., Lukanovic A. "Efficacy of Nonablative Laser Therapy for Lichen Sclerosus: A Randomized Controlled Trial"

J. Obstet Gynaecol Can. 2019; 41 (12): 1717-25.

5. Lee A., Lim A., Fischer G. Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus. Australas J Dermatol. 2016; 57:.39-43. Available online at: https://doi.org/10.1111/ajd.12305

6. Salvatore S., Nappi R.E., Parma M., Chionna R., Lagona F., Zerbinati N., Ferrero S., Origoni M., Candiani M., Leone Roberti Maggiore U. Sexual function after fractional microablative CO₂laser in women with vulvovaginal atrophy. Climacteric. 2015; 18 (2): 219-25.

7. Salvatore S., Nappi R.E., Zerbinati N., Calligaro A., Ferrero S., Origoni M., Candiani M., Leone Roberti Maggiore U. A 12-week treatment with fractional laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014; 17 (4): 363-9.

8. Pagano T., Conforti A., Buonfantino C., et al. Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. Menopause. 2020; 27 (4): 418-22.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)