BACKGROUND
Lichen sclerosus is a chronic inflammatory autoimmune skin disease and the etiology is not well understood. It can affect the female vulvar genital region causing painful, pruritic symptoms that negatively impact a woman’s quality of life. The current primary treatment for vulvar lichen scleorsus (VLS) is topical steroids but a number of other treatments are being studied at this time.
OBJECTIVE
There are numerous recalcitrant VLS cases that require secondary forms of treatment. One of which is the use of fractional CO2 laser therapy, which functions by superficially vaporizing the epidermis creating a microablative effect while also inducing collagen remodeling within the dermis. This review aims to bring awareness to this secondary form of treatment for VLS.
METHODS
Four articles are reviewed that were published in the last year (2020-2021) evaluating the improvements in VLS symptoms after at least two treatments of fractionated CO2 laser therapy.
RESULTS
Three of the four articles included patients that suffered from previously treated VLS experiencing persistent symptoms. Only one of the studies was a randomized controlled trial. The follow-up time ranged from one month to sixteen months. Two studies showed statistically significant improvement in symptoms such as vaginal pain, itching, and dyspareunia. The other two studies reported improvement in these symptoms, however, the results were not statistically significant. Other symptoms noted to show improvement were erythema, leukoderma, and skin elasticity. After five to seven treatments with this CO2 laser, there was also a reduction in erosions and fissures as well as restoration of normal skin color and texture. Adverse events from this treatment included minor burning and blistering at the laser site.
CONCLUSIONS
While the recent published work suggests there may be a benefit to the use of fractionated CO2 laser therapy for recalcitrant VLS, only one of them was a randomized controlled trial. Future studies should be completed with this design. Until then, the treatment should follow guidelines with topical steroids being the primary form of management.
CLINICALTRIAL
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