Treatment of vulvar lichen sclerosus with a fractional CO2 laser — case report
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Abstract
Vulvar lichen sclerosus (VLS) belongs to the group of autoimmune, chronic inflammatory skin disorders and is most frequent in females after their 50s. This disease might lead to vulvar scarring, sexual dysfunction and neoplasm transformation. For that reason, treatment of VLS is still considered an important clinical issue from the borderline of gynaecology and dermatology. Classical treatment includes the use of corticosteroids, which help to relieve symptoms, prevent further scarring of the vulva, reduce inflammation and reduce the risk of malignant transformation. Due to the resistance of some patients to local treatment and its complications, however, the use of fractional CO2 lasers in the treatment of VLS has been proposed. A 41-year-old female patient presented to a gynaecologist with symptoms such as itching, burning, and cracking of the vulva skin. A tissue sample was taken from the affected area and a histopathological examination confirmed the initial diagnosis. Treatment with topical glucocorticosteroids was applied, but no improvement was noticed. For that reason, a CO2 fractional laser was applied to the therapy with complementary treatment in the form of topical glucocorticosteroids. After 1.5 years, regression of lesions on the skin of the vulva was observed. This case report highlight the effectiveness of fractioned CO2 laser in the treatment of VLS resistant to glucocorticosteroid monotherapy.
Keywords: vulvar lichen sclerosuslichen sclerosusCO2 laserfractional CO2 laser
References
- Singh N, Ghatage P. Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review. Obstet Gynecol Int. 2020; 2020: 7480754.
- Cooper SM, Gao XH, Powell JJ, et al. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004; 140(6): 702–706.
- Bleeker MCG, Visser PJ, Overbeek LIH, et al. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev. 2016; 25(8): 1224–1230.
- Corazza M, Schettini N, Zedde P, et al. Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines. 2021; 9(8).
- Marfatia Y, Surani A, Baxi R. Genital lichen sclerosus et atrophicus in females: An update. Indian J Sex Transm Dis AIDS. 2019; 40(1): 6–12.
- Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018; 178(4): 839–853.
- Cooper SM, Ali I, Baldo M, et al. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol. 2008; 144(11): 1432–1435.
- Preti M, Joura E, Vieira-Baptista P, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions. J Low Genit Tract Dis. 2022; 26(3): 229–244.
- Baggish MS. Fractional CO 2 Laser Treatment for Vaginal Atrophy and Vulvar Lichen Sclerosus. Journal of Gynecologic Surgery. 2016; 32: 309–17.
- Lee A, Lim A, Fischer G. Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus. Australas J Dermatol. 2016; 57(1): 39–43.
- Stewart K, Javaid S, Schallen KP, et al. Fractional CO laser treatment as adjunctive therapy to topical steroids for managing vulvar lichen sclerosus. Lasers Surg Med. 2022; 54(1): 138–151.
- Mitchell L, Goldstein AT, Heller D, et al. Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021; 137(6): 979–987.
- Tasker F, Kirby L, Grindlay DJC, et al. Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base. Skin Health Dis. 2021; 1(3): e52.
- Omi T, Numano K. The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology. Laser Ther. 2014; 23(1): 49–60.
- Mauskar MM. Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus. Obstet Gynecol. 2021; 137(6): 965–967.
- Ferrara F, Filippi F, Messori S, et al. Fractional CO2 laser and vulvar lichen sclerosus: an alternative resource during maintenance therapy? A prospective study. Ital J Dermatol Venerol. 2022; 157(3): 247–253.