Vulvar leukoplakia: therapeutic options

Abstract

Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes. They both lead to significant impairment of quality of life, risk of malignancy, as well as recurrence after treatment. Treatment of these conditions includes topical corticosteroids as a first-line therapy, but they have their side effects and not all patients are receptive to this therapy. This requires the use of alternative therapeutic options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and, as a last resort, surgical removal of affected tissues. Surgical treatment should be avoided, despite the malignant potential, because of recurrence risk in both diseases New therapeutic approaches are coming into effect in gynaecological practice due to potential risks of the above-mentioned methods. Platelet-rich plasma therapy, ablative and non-ablative laser treatment, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional medications. A number of them are still in their initial phase of application and time will tell their effectiveness.

Vulvar lichen sclerosus: recent advances in understanding and management

“…Asymptomatic VLS cases should be treated too. 28 There are a number of treatment options that have been tried to achieve the remission and prevent progression of the disease, are described below in the Table 2. Topical calcineurin inhibitors…”

“…These drugs have a pronounced anti-inflammatory, an immunomodulatory and a weakly pronounced immunosuppressive effect. 28 They reduce itching and inflammation by blocking T-cell activation and suppressing the release of cytokines from Tcells. They do not inhibit collagen synthesis so they do not cause dermal atrophy, which may be especially useful in pediatric patients.…”

“…But now a days their use has been stopped due to worse results compared to those of ultrapotent topical corticosteroids and their side effects (systemic absorption and virilizing effects in female patients). 28,30…”

“…Also, contraindicated in pregnancy because of teratogenic effect. 28,30 Other local pharmacologic agents Topical oxatomide helps relieve pruritus through its antihistaminic effects, but the course of disease is not affected. 3 Therapy with TheresienOl (herbal oil) twice daily for two to three months has been found to be effective in relieving clinical symptoms of VLS.…”

“…Non-ablative ones, unlike ablative lasers, have no side effects such as pain, discomfort, scars, infections, pigmentation or bleeding. 28,30 There is an ongoing trial on the MonaLisa touch laser (DEKA Laser, Florence, Italy) looking at the efficacy and safety of the micro-ablative fractional CO2 laser treatment (FxCO2) for VLS (Trial no. NCT03665584).…”