Laser Therapy for Vulvar Lichen Sclerosus, a Systematic Review

Area of Science:

• Dermatology
• Gynecology
• Medical Technology

Background:

• Lichen sclerosus (LS) is a chronic inflammatory condition impacting the anogenital region, predominantly in post-menopausal women.
• LS can cause significant vulvar architectural changes and potentially progress to squamous cell carcinoma.
• Current first-line treatment relies on potent topical corticosteroids, with limited established second-line options.

Purpose of the Study:

• To evaluate the existing evidence for laser therapy as a treatment for lichen sclerosus.
• To assess the efficacy and safety of laser therapy compared to established treatments and placebo.

Main Methods:

• A systematic literature search was performed across major databases (MEDLINE/PubMed, Embase, Web of Science, Scopus, CENTRAL) for studies published before April 2023.
• Six studies involving 177 patients were included, with five comparing laser therapy to topical corticosteroids.
• Methodological quality and risk of bias were assessed using the Cochrane RoB-2 tool.

Main Results:

• Laser therapy demonstrated comparable histological outcomes to topical corticosteroids, with increased collagen production noted.
• Significant improvements in itching, pain, and dyspareunia were observed at 1 and 3 months in the laser group.
• Patient satisfaction was higher with laser therapy, which exhibited excellent tolerability. No significant differences were found compared to placebo.

Conclusions:

• While laser therapy shows potential benefits for lichen sclerosus symptom relief and patient satisfaction, current evidence is insufficient to support its use as a standalone treatment.
• Further high-quality research is required to establish definitive treatment guidelines incorporating laser therapy.