Clinical study on multi-focused laser in the treatment of vulvar lichen sclerosus

Guo, Jing-Qiu; Chen, Songyan; Song, Yu; Liu, He-Yu; Hu, Lina; Zhu, Zhengyan

doi:10.3389/fsurg.2022.919135

Cited by 3 publications

(11 citation statements)

References 13 publications

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“…However, as we analysed a novel treatment technique-at time of study initiation in 2019 without precedent nor previous data on efficacy and side effects-we chose a timely evaluation. This was similar to other studies, 5,10,11 and allowed the interpretation/comparison of unambiguous laser versus steroid effects without influence of crossover treatments.…”

Section: Strengths and Limitationssupporting

confidence: 84%

“…14 As the wavelength of the Nd:YAG laser is not absorbed by water, the laser beam penetrates without surface tissue damage (>5 mm). Therefore, in contrast to the CO 2 laser, 9,11,12 the non-ablative Nd:YAG laser treatment of the vulva is less painful. It only required the administration of topical anaesthetics in 4.5% of all treatments.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the dual Nd:YAG/Er:YAG laser treatment was safe and efficient, which was in agreement with other vulvovaginal laser treatments of LS. 8 Four previously published RCTs also compared laser and topical steroid, three of them used the CO 2 laser, 9,11,12 and one used the Nd:YAG laser. 5 Two RCTs compared CO 2 with placebo/sham or 'low-dose' CO 2 laser.…”

Section: Discussionmentioning

confidence: 99%

“…The number of patients was equal or higher than in published RCTs on LS. 5,[9][10][11][12][13] Another strength is the high adherence to both treatment arms. This reflects that treatments in both arms were well tolerated.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…6 Most cohort studies and randomised controlled trials (RCTs) used the fractionated ablative CO 2 laser (10 600 nm). [8][9][10][11][12][13] In this study, we investigated the safety, tolerability and efficacy of a novel dual neodymium:yttrium-aluminium-garnet (Nd:YAG)/erbium:yttrium-aluminium-garnet (Er:YAG) laser concept for the treatment of vulvar LS. In contrast to the CO 2 laser, the non-ablative Nd:YAG laser beam (1064 nm) penetrates through hyperkeratotic and sclerotic tissue layers without damaging the sensitive vulvar epithelium.…”

Section: Introductionmentioning

confidence: 99%

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Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial

Zivanovic,

Gamper,

Fesslmeier

et al. 2023

BJOG

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ObjectiveTo evaluate the efficacy and safety of a novel non‐ablative Nd:YAG/Er:YAG dual laser treatment for vulvar lichen sclerosus (LS) in comparison with the recommended first‐line therapy with topical steroid.DesignA randomised investigator‐initiated active‐controlled trial.SettingSingle tertiary referral centre.PopulationWomen with vulvar LS.MethodsRandomisation (2:1) to Nd:YAG/Er:YAG laser therapy or topical clobetasol proprionate therapy. Four laser treatments at 0, 1, 2 and 4 months or decreasing doses of steroid for 6 months.Main Outcome MeasuresThe primary outcome was the change in objective validated clinical LS score in the laser arm between baseline and 6 months. Secondary outcomes were laser tolerability/safety, symptom scores and patient satisfaction.ResultsSixty‐six women were included, 44 in the laser group and 22 in the steroid group. The total LS score decreased by −2.34 ± 1.20 (95% CI −2.71 to −1.98) in women treated with laser compared with a decrease of −0.95 ± 0.90 (95% CI −1.35 to −0.56) in those receiving steroid applications (p < 0.001). Laser treatment was safe and well tolerated. Subjective severity scores (on visual analogue scale) and vulvovaginal symptoms questionnaire scores improved similarly for the laser and steroid arms without significant differences between the two treatments. Patient satisfaction was higher in the laser arm than in the steroid arm (p = 0.035).ConclusionsNon‐ablative dual Nd:YAG/Er:YAG laser therapy was safe and significantly improved clinical outcome and subjective symptoms at the 6‐month follow up. This suggests that laser may be a promising alternative to corticosteroid therapy. However, the authors caution regular follow ups because of the premalignant nature of the disease.

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Section: Strengths and Limitationssupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial

Zivanovic,

Gamper,

Fesslmeier

et al. 2023

BJOG

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Device-based physical therapies in chronic pruritus: A narrative review

Zhu,

Zhao,

Navarini

et al. 2024

Journal of the American Academy of Dermatology

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Treatment Modalities for Genital Lichen Sclerosus: A Systematic Review

Conte,

Daraj Mohamed,

Shergill

et al. 2024

Dermato

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Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that affects both genital and extragenital sites. It is often difficult to treat and may lead to a variety of complications if not adequately treated. The mainstay of therapy involves topical corticosteroids, topical calcineurin inhibitors, and systemic immunomodulators. Although a variety of topical, oral, and procedural therapies are available, a review comparing relative efficacy is lacking. To this end, this systematic review aimed to summarize the literature regarding treatment modalities and their respective response rates in patients with genital LS. Methods: A literature search was conducted in accordance with PRISMA guidelines. Results: This review qualitatively summarizes information from 31 randomized controlled trials, encapsulating a total of 1507 patients with LS, the majority of which were female (n = 1374, 91%). Topical corticosteroids, the mainstay of therapy for LS, were discussed throughout the literature, and proved to be more efficient than topical calcineurin inhibitors, topical hormonal therapy, topical vitamin E oil and cold cream. However, other treatment modalities proved to be more efficient than topical corticosteroids, including CO2 and Nd:YAG laser therapies, and the addition of polydeoxyribonucleotide intradermal injections, to steroid therapy. Finally, other modalities that proved to be efficient in the treatment of LS included silk undergarments, human fibroblast lysate cream, platelet-rich plasma, acitretin, and surgical intervention. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Limitations included the inclusion of only randomized controlled trials, moderate or high risk of bias, and heterogeneity in treatment regimens, among others. Conclusion: Although high-potency topical corticosteroids have validated efficacy in the management of LS, other treatment modalities, including steroid-sparing agents and/or procedural adjuncts, have been demonstrated to have a beneficial role in the treatment of LS.

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Clinical study on multi-focused laser in the treatment of vulvar lichen sclerosus

Cited by 3 publications

References 13 publications

Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial

Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomised controlled trial

Device-based physical therapies in chronic pruritus: A narrative review

Treatment Modalities for Genital Lichen Sclerosus: A Systematic Review

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