Retrospective Study on CO2 Laser for Second-Line Treatment of Vulvar Lichen Sclerosus

Background: Vulvar Lichen Sclerosus (VLS) represents a persistent inflammatory disease of the skin that particularly affects the genital area. Aim: The study purpose was to investigate the effectiveness of CO2 laser as a treatment of recalcitrant VLS. The parameters examined included treatment tolerance, patient satisfaction, symptoms, and VLS clinical markers. Methods: This retrospective study enrolled 85 adult women affected by Vulvar Lichen Sclerosus (VLS), refractory to local corticosteroids. Patients were treated with three sessions of fractional CO2 laser treatment at 4-week intervals. For vulvovaginal treatment, a device with a scanning handpiece and dedicated probes was used. The effectiveness of the treatment was evaluated at 1 month follow up (T1) and at 6 months follow up (T2) from the last treatment session. The Vulvar Health Index (VuHI) and the Vaginal Health Index score (VHI) were used. Patients assessed the severity of their symptoms (dyspareunia and dryness specifically) using the Visual Analogue Scale (VAS), a 10-point scale going from 0 (no symptoms) to 10 (maximum symptoms). Results: VuHI showed significant improvement after completion of treatment compared to baseline (p < 0.001). VHI showed significant improvement after completion of treatment compared to baseline (p < 0.001). There was clear improvement, compared to baseline values, in the VAS score for superficial dyspareunia and for vulvar dryness. Conclusion: Overall, the results of this study demonstrated that treatment of recalcitrant VLS with fractional CO2 laser improved both clinical assessment and symptoms.