Managing vulvar lichen sclerosus with fractional CO2 lasers

Skin conditions, such as vulvar lichen sclerosis (VLS), often go untreated until advanced signs of skin damage occur. While topical steroid treatment is aimed at relieving symptoms and preventing further damage, many patients are recalcitrant to high potency topical steroid therapy.  Fractional CO2 lasers have been shown histologically to improve vaginal tissue and alleviate vulvar symptoms of itching and dyspareunia. 

To determine the success of fractional CO2 treatment as an adjunctive therapy to high potency steroids for managing VLS, investigators led a clinical study evaluating a series of CO2 treatments to improve clinical signs and architectural changes associated with VLS, and as an adjunctive therapy, to maintain symptomatic control of the disease.
Female subjects received up to five CO2 laser treatments at four-week intervals to the external vulva using the CO2RE device with Intima handpiece.  Investigators assessed the severity of clinical signs and architectural changes following the treatments.  Subjects reported on the presence of symptoms and the quality of life and sexual function, as well as discomfort associated with the treatment. 

As presented at the 2019 North American Menopausal Society Annual Meeting, clinical signs demonstrated improvements in whitening (91%), parchment-like skin (91%), elasticity (90%), sclerosus (89%), lichenification (63%) and labial fusion (36%).  75% of subjects showed improvement in introital dyspareunia and 83% showed improvement in skin tearing or post-coital bleeding with intercourse.

In addition, following the entire treatment series, 91% of subjects reported improvements to their quality of life and 88% reported improved sexual function.

6-month post treatment outcomes were then presented at the American Society for Laser Medicine and Surgery 2020 Annual Meeting.  Results demonstrated a highly significant improvement in elasticity, whitening and lichenification as compared to baseline.  Significant improvements were also seen in sclerosus and parchment-like skin. 100% of subjects reported improved sexual function and 91% showed improvement in quality of life.

Fractional Carbon Dioxide (CO2) Laser Treatment as Adjunctive Therapy to High-Potency Topical Steroids for Managing Vulvar Lichen Sclerosus
Sunbal Javaid, M.D. FACOG; Sarah Bartlett, M.D. FACOG; Konika Patel Schallen, M.D.; Kristen Stewart, M.D. FAAD
Six-month Outcomes After Fractional CO2 Laser Treatment for Managing Vulvar Lichen Sclerosus
Stewart, Kristen M.D., ASLMS 2020