Fractional CO2 laser and vulvar lichen sclerosus: an alternative resource during maintenance therapy? A prospective study

Background: Lichen sclerosus is an autoimmune dermatosis that in women typically involves vulvar area. This condition can strongly impact on the quality of life. To date, topical steroids are the most effective treatment, although adverse effects are possible, especially in long-term application. The aims of this study are: 1) to investigate the efficacy of fractional CO2 laser in reducing symptoms of vulvar lichen sclerosus (VLS) during maintenance therapy with topical steroids (application twice weekly or less); 2) to assess how long this reduction of symptoms persists during follow-up; 3) histological comparison before and after treatment. To our knowledge, this is the first prospective study evaluating this treatment in women with VLS. Methods: Women with a diagnosis of VLS were prospectively enrolled and treated with fractional CO2 laser every 2 months, for a total of 3 sessions. Four questionnaires were periodically administered: the Dermatology Quality of Life Index (DLQI), the Female Sexual Functional Index (FSFI) and two specific questionnaires created to assess the severity of disease. Results: Twenty-three adult women were enrolled. The fractional CO2 laser treatment significantly improved the scores of all scales from baseline to T4 questionnaires. Conclusions: Fractional CO2 laser proved to be effective on VLS symptoms and can be considered an alternative to corticosteroids during maintenance therapy. Larger studies with a control group and randomization are needed to safely generalize our findings.