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Lichen Sclerosus et Atrophicus - Comparison of Laser Treatment vs. Topical Steroids, Preliminary Results
IUGA Academy. Bizjak-Ogrinc U. Jun 30, 2018; 212928; 544
Dr. Urska Bizjak-Ogrinc
Dr. Urska Bizjak-Ogrinc

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544

Lichen sclerosus et atrophicus - Comparison of laser treatment vs. topical steroids, preliminary results

Bizjak-Ogrinc, U1; Sencar, S1; Lukanovic, A2;Vizintin, Z3

1: Juna Clinic; 2: Division of Gynecology Clinic at University Medical Centre Ljubljana; 3: Fotona

Introduction: Lichen sclerosus (LS) is a chronic skin disease of unknown cause and very unpleasant symptoms which significantly influences the quality of life of the affected patients. Large majority of LS lesions is located in anogenital region where initial white flat papules usually develop into large, white patches of thin, itchy skin causing fusion of labia minora, narrowing of the introitus and burying of the clitoris. Most common symptoms are itching, pain, soreness, burning, dyspareunia and dysuria all strongly interfering with sexual function and patient’s self image. Existing treatment options with systemic and topical medications (oral retinoids, topical steroids) have some drawbacks and recently the use of laser was proposed for treatment of LS.

Background and Objective: In this paper we are reporting about preliminary results of laser treatment of lichen sclerosus and are giving the first assessment of efficacy and safety of this new laser therapy.

Methods: This is randomized control trial performed in two medical centers in Slovenia. Included were female patients older than 18 years and with histologically proven lichen. Patients were randomized into two groups. Study group received three laser treatments every 14 days, while the control group was receiving topical corticosteroids for 3 weeks with decreasing dose. Laser treatment consisted of combination of non-ablative NdYAG using Piano (5 sec) pulses and of fractional ablative ErYAG. The improvement was assessed with: biopsies; pictures grading on 4 grade scale and VAS (1-10) for dyspareunia and itching. Follow-ups were scheduled at 1, 3 and 6 months.

Results: 40 patients were randomized into study (laser) group and control (corticosteroid) group with 20 patients each. All 20 patients from laser and 19 patients from control group completed the treatments and were followed up for 1, 3 and 6 months (laser group) and for 1 and 3 months (control). VAS score for dyspareunia in laser group changed from 6.60 to 0.55 (1M), 0.50 (3M) and 1.88 (6M) while itching score went from 7.15 to 1.05, 0.75 and 1.81. Control group had dyspareunia reduced from 5.50 to 2.64 (1M) and 3.27 (3M). Similarly itching in control group reduced during the treatment from 8.56 to 4.79 (1M) and 5.47 (3M). Treatment discomfort was very low (average score of 1.5).The adverse effects were all mild and transient.

Conclusions: Preliminary results of laser therapy for lichen sclerosus demonstrated good efficacy and minimal patient discomfort during the treatment, with no adverse effects. In comparison with control group laser showed equally good but longer lasting improvement. However we have to wait until the final results to see if they will confirm the promising findings of this preliminary study stage.

Disclosure:

Work supported by industry: yes, by Fotona. A consultant, employee (part time or full time) or shareholder is among the authors (Fotona).

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