Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base

Abstract

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis. Initial treatment with superpotent topical corticosteroids is the accepted and evidence-based first-line therapy. For those who do not respond after exclusion of other potentiating factors, the best second-line therapy is unclear. Laser therapy is an emerging treatment for genital LS and despite uncertain efficacy its use is gaining popularity in the private sector. Objectives: We aimed to review the effectiveness of laser therapy for genital LS in men, women and children. Methods: We conducted a systematic review of all primary studies reporting the use of laser in genital LS. Ovid MEDLINE, PubMed, Ovid Embase, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO were searched from inception to February 2021. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials, ROBINS-I tool for non-randomized trials and Joanna Briggs Institute checklist for case studies. Results: A total of 24 studies, involving 616 adults, met inclusion criteria. These were six randomized controlled trials (RCTs), one non-randomized trial, nine single arm trials and eight case series. Where assessed, most studies suggest that laser therapy in patients with LS may improve symptoms, clinical signs, quality of life and sexual function. However, results were highly heterogeneous and methodological quality was very low, therefore meta-analysis was not possible. Conclusions: There is poor evidence to support the use of laser therapy for genital LS at present. Effectiveness of laser needs to be robustly investigated in well-conducted RCTs. | INTRODUCTIONLichen sclerosus (LS) is a chronic, inflammatory dermatosis, with predilection for genital skin. The incidence of LS is 1.6% in women by age 80. 1 Symptoms include intense itch, soreness and dyspareunia. Anatomical changes with resorption of the labia minora and fusion of the clitoral hood can occur. Scarring from dermal inflammation causes anatomical alteration. In males, LS typically occurs on the glans penis and foreskin, leading to phimosis, difficulty with micturition and dyspareunia. 2 LS also affects children although this is less common. LS has considerable impact on quality of life and psychosocial and sexual well-being. 3,4 In addition, a small proportion (3%-5%) develop malignancy. [5][6][7] First-line treatment with super-potent topical corticosteroids is the accepted evidence-based therapy. 8This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

2021 European guideline for the management of vulval conditions

“…However, a systematic review concluded that there is no high quality evidence to support the use of laser for the treatment of LS in males or females. Long‐term data of laser are lacking including its adverse effects 79 …”

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state‐of‐the‐art review

“…Tasker et al investigated the use of CO 2 LASER for LS in a systematic review; a meta‐analysis could not be done, as the studies were too heterogenous. They rated all included RCTS as ‘high risk of bias’, including two RCTs from the present review 36,37,140 …”

“…They rated all included RCTS as 'high risk of bias', including two RCTs from the present review. 36,37,140 Vaginal LASER therapy is often highlighted as a potential treatment alternative for women with hormone-sensitive diseases in the literature on vaginal LASER. 6 All observational studies on CO 2 and Er.YAG LASER, which include women with BC or gynecologic cancer, show significant improvement in GSM and VVA symptom severity.…”

Treatment of vulvar lichen sclerosus with a fractional CO2 laser — case report

“…Also, a systematic review conducted by Tasker F. et al highlight that the effectiveness and safety of fractioned CO2 laser in VLS therapy must be verified in well-planned randomized clinical trials. The authors analysed 24 studies with 616 participants, all studies which met inclusion criteria concerned using of fractioned CO2 laser in the treatment of genital LS (lichen sclerosus) in both sexes [13].…”