Energy-based therapies for vulvar lichen sclerosus: A systematic review of randomized controlled trials

Vulvar lichen sclerosus (VLS) is a chronic, relapsing dermatosis that significantly impairs quality of life. While topical corticosteroids remain the first-line therapy, recurrence and steroid-related side-effects have prompted interest in alternative options. This systematic review evaluates the efficacy and safety of laser therapies compared with other treatments for VLS.

A systematic search was performed in MEDLINE (via PubMed), Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches used Medical Subject Headings (MeSH) and free-text terms. Randomized controlled trials (RCTs) meeting predefined criteria were included. Two independent reviewers assessed study eligibility and methodological quality using the JBI critical appraisal checklist for RCTs; discrepancies were resolved by a third reviewer.

Seven RCTs involving 337 women were included. The majority of studies evaluated fractional CO₂ laser therapy, while others investigated Nd:YAG-based or combination laser modalities. Comparators included sham or low-dose laser, topical corticosteroids, and other active treatments. Five of the seven RCTs found improvements in patient-reported symptoms following laser therapy; however, findings were heterogeneous and not consistently superior to comparator groups. The only sham-controlled trial did not demonstrate superiority of fractional CO₂ laser over sham treatment, suggesting a substantial placebo contribution. Patient satisfaction and adherence were generally higher with laser therapy, and no serious adverse events were reported.

Laser therapies appear promising for VLS management, with favorable safety and patient-reported outcomes. Nevertheless, current evidence is limited by small cohorts and methodological heterogeneity. Larger randomized, sham-controlled trials are required to validate efficacy and long-term safety.