Photodynamic Therapy for Vulvar Lichen Sclerosus—A Systematic Review

Prodromidou, Anastasia; Chatziioannou, Eftychia; Daskalakis, Georgios; Stergios, Kostantinos; Pergialiotis, Vasilios

doi:10.1097/lgt.0000000000000362

Cited by 30 publications

(12 citation statements)

References 23 publications

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“…PDT led to significant improvement in symptoms related to LS, but changes in histopathologic inflammation were inconsistent. 69 Although PDT seems promising, additional research is needed to determine efficacy of this treatment modality.…”

Section: Photodynamic Therapymentioning

confidence: 99%

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

Krapf

Mitchell

Holton

et al. 2020

IJWH

114

145

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Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including plateletrich plasma therapy and energy-based modalities such as the fractional CO 2 laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.

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Section: Photodynamic Therapymentioning

confidence: 99%

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

Krapf

Mitchell

Holton

et al. 2020

IJWH

114

145

View full text Add to dashboard Cite

show abstract

“…It has a bimodal age distribution; its incidence peaks at prepubertal and postmenopausal ages. Even though several environmental and genetic factors were accused, it is believed that autoimmunity and chronic inflammation play essential roles in its pathogenesis [8][9][10]. Karadag et al [11] investigated 350 LS patients, 98% of which had vulvar involvement, and reported that autoimmune antibodies (anti-thyroid, anti-nuclear, anti-mitochondrial antibodies) were detected in 22%.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term treatment with these agents does not lead to regional atrophy, which is their main advantage over corticosteroids [2]. Other treatment options are oral acitretin, cyclosporin, methotrexate, topical progesterone, testosterone, ultraviolet A1 phototherapy, and photodynamic therapy [1,[8][9]. However, in complicated VLS which presents with structural deformities, severe adhesions, and scar formation, surgical treatment is indicated [25,26].…”

Section: Discussionmentioning

confidence: 99%

The effect of vulvar lichen sclerosus on quality of life and sexual functioning

Helvacıoğlu¹,

Topkarcı²,

Helvacıoğlu³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition that has the potential to cause sexual dysfunction and reduction in patients' life quality. We aimed to evaluate the quality of life and sexual function in female patients with VLS. Methods: This prospective case-control study was conducted with women who presented to the gynecology clinic with a biopsy-proven diagnosis of VLS or for routine gynecological check-ups between June 2017-January 2018. The patients were grouped according to the presence or absence of VLS. Effects of VLS on quality of life and sexual functions were analyzed with the Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) questionnaires. Results: A total of 86 women were included in this study. Thirty-seven VLS patients were compared with 49 patients without VLS. The total DLQI scores of the VLS and control groups were 6.14 (6.87) and 1.92 (2.41), respectively (P=0.001), and the total FSFI scores, 15.42 and 24.22, respectively (P<0.001). Subgroup analyses revealed that the two groups significantly differed in terms of sexual desire, arousal, orgasm, satisfaction, and pain (P<0.001), but not in terms of lubrication (P=0.741). Conclusion:Vulvar lichen sclerosus negatively affects the quality of life and sexual function. Questionnaires such as DLQI and FSFI are useful tools for the assessment of sexual function and quality of life in these patients. Since these patients may be hesitant to report their sexual problems, healthcare professionals should interrogate them in this regard during the early stages of management.

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“…The pathophysiologic rationale of photodynamic therapy (PDT) is based on the conversion of ALA and methyl δ-ALA into the photosensitizing metabolic products called protoporphyrins. By activating protoporphyrins with the appropriate wavelength, PDT induces production of ROS, like superoxide, and singlet oxygen [198]. These reactions ultimately result in apoptosis of lymphocytes and keratinocytes, as well as in alteration of the expression of both cytokines and MMPs, which play a role in skin remodelling.…”

Section: Photodynamic Therapymentioning

confidence: 99%

Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

et al. 2021

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Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.

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Photodynamic Therapy for Vulvar Lichen Sclerosus—A Systematic Review

Abstract: According to the findings of our study, PDT seems to be promising in the treatment of patients with vulvar LS. Nonetheless, current knowledge is extremely limited, and further observational studies with large patient series are needed in the field to elucidate the efficacy of PDT.

Cited by 30 publications

References 23 publications

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

The effect of vulvar lichen sclerosus on quality of life and sexual functioning

Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

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