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Adjunctive fractional CO2 laser treatment improves symptoms of vulvar lichen sclerosus

Kristen Stewart

CHICAGO — Fractional CO₂ laser treatment was associated with improved signs and symptoms of vulvar lichen sclerosus, according to data from a pilot study presented at the American Society for Dermatologic Surgery annual meeting.

“Lichen sclerosus is a chronic condition that has a severe detrimental effect on quality of life for women and is probably more common than we suspect and very underdiagnosed. Topical steroids are the primary treatment; however, monotherapy often is inadequate to control symptoms and disease progression,” Kristen Stewart, MD, dermatologist at Skin and Cancer Associates Center for Cosmetic Enhancement in Jacksonville, Florida, said during her presentation.

Eleven women with biopsy-confirmed and/or clinically observed vulvar lichen sclerosus who were refractory to high-potency topical steroids underwent three to five fractional CO₂ laser treatments. The mean age of participants was 57 years and 10 women had postmenopausal status between 2 and 19 years.

Participants taking topical steroids and exogenous hormone treatments were able to continue doing so. Severity of clinical signs (not present = 0, mild = 1, moderate = 2, severe = 3) and architectural changes were examined after treatment, and patients used 5-point scales to report symptoms and their effects on quality of life and sexual function. After the final treatment, researchers will report on clinical evaluations, self-reported symptoms and sexual function according to the Female Sexual Function Index at 3-, 6- and 12-month follow-up.

Baseline signs included parchment-like skin, loss of elasticity, sclerosus, whitening, lichenification and labial fusion, according to the abstract. Most commonly reported symptoms were superficial dyspareunia, skin tearing or bleeding, a negative impact on quality of life and decreased sexual function.

Improvements in elasticity occurred among 100% of patients at 6-week and 3-month follow-up (P < .01), 86% showed improvement in sclerosus at 6-week follow-up and 78% at 3-month follow-up (P < .05). Lichenification improved in 83% of patients at 6-week follow-up and 100% at 3-month follow-up (P < .01). Similarly, whitening and parchment-like skin improved in 78% at 6-week follow-up and 82% at 3-month follow-up (P < .01 for whitening; P < .05 for parchment-like skin). Labial fusion also improved among 44% of patients at 6-week follow-up and 40% at 3-month follow-up.

“At 3-month follow-up, nearly 80% of patients had improvement in superficial dyspareunia and 70% had improvement in skin tearing and external bleeding associated with intercourse,” Stewart said. – by Stacey L. Adams

Reference:

Stewart K, et al. Fractional CO2 laser treatment as adjunctive therapy to high-potency topical steroids for managing vulvar lichen sclerosus: Preliminary findings of a pilot study. Presented at: American Society for Dermatologic Surgery Annual Meeting; Oct. 24-27, 2019; Chicago.

Disclosure: Stewart reports she is primary investigator for a study sponsored by Candela and a speaker and consultant for AbbVie.