Fractionated CO2 Laser as Therapy in Recalcitrant Lichen Sclerosus

The aim of this study was to evaluate the efficacy of the fractionated CO2 laser in treating recalcitrant lichen sclerosus (LS).

The study population was 40 women diagnosed with LS who were symptomatic despite medical treatment. Patients had at least 2 or more laser sessions with a 2-month follow-up visit at the Drexel Vaginitis Center. A fractionated CO2 laser was used on affected areas at mild or standard power settings. Analyses were performed of changes in symptom rating scales, verbal reports, and physical examination findings.

In the LS cohort of 40 patients, 22 women (55%) experienced symptoms that had persisted longer than 5 years before treatment. After the appropriate laser sessions, 72.5% of women described their improvement as significant or more than 66% improvement. In addition, there was a statistically significant reduction in vaginal pain, itching, dyspareunia, and dysuria. The presence of white epithelium decreased 20% after treatment. Furthermore, the mean corticosteroid use declined from 4.28 times per week to 2.04 times per week, indicating a resolution of many symptoms.

The fractionated CO2 laser may be a helpful approach for managing LS that is unresponsive to traditional treatment options.