A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy.
A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy.
- 2023
CONCLUSIONS: In postmenopausal women with vulvar LS undergoing fractionated CO2 laser, symptomatic improvements correlated with histologic change in degree of sclerosis on vulvar biopsy. These results demonstrate FxCO2 laser therapy as a promising option for the treatment of LS and suggest that further studies should assess degree of sclerosis on histopathology. Copyright 2023 Wiley Periodicals LLC. METHODS: This prospective single-arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten postmenopausal women with biopsy-proven LS planning FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, topical corticosteroid use within 8 weeks, prior pelvic radiation, malignancy, active genital infection, or pregnancy. The vulvovaginal SmartXide2-V2-LR laser system fractionated CO2 laser (DEKA) was utilized to treat visually affected areas of vulvar and perianal LS with a single pass. Subjects underwent three treatments 4-6 weeks apart. Subjects completed the Skindex-16 questionnaire and had vulvar biopsy at baseline and at 4 weeks after completion of fractionated CO2 laser therapy. Blinded histologic slides were scored by one dermatopathologist (Michael A. Cardis) rating from 1 to 5 the degree of dermal sclerosis, inflammation, and epidermal atrophy. Change scores were calculated as the difference between pre- and post-treatment scores for each subject. OBJECTIVES: To investigate the histologic characteristics of vulvar tissues before and after completion of fractionated carbon dioxide (CO2 ) laser therapy (FxCO2) for vulvar lichen sclerosus (LS). The secondary objective was to assess subjective improvement in symptoms via the Skindex-16 questionnaire. RESULTS: The 10 subjects enrolled had a mean age of 61 and most were white, privately insured, and had a college/graduate-level education. Post-fractionated CO2 laser treatment vulvar biopsies showed significant improvement in sclerosis and epidermal atrophy compared with pretreatment baseline biopsy specimens (p < 0.05) with no statistically significant change found in inflammation score. Skindex-16 and FSFI scores showed a trend towards improvement (p > 0.05 for both). A statistically significant correlation was found between change in sclerosis and Skindex-16 symptoms scores with an average change of 21.4 units in Skindex-16 symptoms score for every one-point change in histologic sclerosis score (p = 0.03).
English
0196-8092
10.1002/lsm.23669 [doi]
*Lichen Sclerosus et Atrophicus
*Vulvar Lichen Sclerosus
Atrophy/co [Complications]
Biopsy
Carbon Dioxide
Female
Humans
Inflammation
Lichen Sclerosus et Atrophicus/co [Complications]
Lichen Sclerosus et Atrophicus/pa [Pathology]
Middle Aged
Pilot Projects
Postmenopause
Prospective Studies
Sclerosis/co [Complications]
Vulvar Lichen Sclerosus/co [Complications]
Vulvar Lichen Sclerosus/pa [Pathology]
Vulvar Lichen Sclerosus/th [Therapy]--Automated
Dermatology
MedStar Health Research Institute
MedStar Washington Hospital Center
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Infectious Diseases Fellowship
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Obstetrics and Gynecology
Case Reports
CONCLUSIONS: In postmenopausal women with vulvar LS undergoing fractionated CO2 laser, symptomatic improvements correlated with histologic change in degree of sclerosis on vulvar biopsy. These results demonstrate FxCO2 laser therapy as a promising option for the treatment of LS and suggest that further studies should assess degree of sclerosis on histopathology. Copyright 2023 Wiley Periodicals LLC. METHODS: This prospective single-arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten postmenopausal women with biopsy-proven LS planning FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, topical corticosteroid use within 8 weeks, prior pelvic radiation, malignancy, active genital infection, or pregnancy. The vulvovaginal SmartXide2-V2-LR laser system fractionated CO2 laser (DEKA) was utilized to treat visually affected areas of vulvar and perianal LS with a single pass. Subjects underwent three treatments 4-6 weeks apart. Subjects completed the Skindex-16 questionnaire and had vulvar biopsy at baseline and at 4 weeks after completion of fractionated CO2 laser therapy. Blinded histologic slides were scored by one dermatopathologist (Michael A. Cardis) rating from 1 to 5 the degree of dermal sclerosis, inflammation, and epidermal atrophy. Change scores were calculated as the difference between pre- and post-treatment scores for each subject. OBJECTIVES: To investigate the histologic characteristics of vulvar tissues before and after completion of fractionated carbon dioxide (CO2 ) laser therapy (FxCO2) for vulvar lichen sclerosus (LS). The secondary objective was to assess subjective improvement in symptoms via the Skindex-16 questionnaire. RESULTS: The 10 subjects enrolled had a mean age of 61 and most were white, privately insured, and had a college/graduate-level education. Post-fractionated CO2 laser treatment vulvar biopsies showed significant improvement in sclerosis and epidermal atrophy compared with pretreatment baseline biopsy specimens (p < 0.05) with no statistically significant change found in inflammation score. Skindex-16 and FSFI scores showed a trend towards improvement (p > 0.05 for both). A statistically significant correlation was found between change in sclerosis and Skindex-16 symptoms scores with an average change of 21.4 units in Skindex-16 symptoms score for every one-point change in histologic sclerosis score (p = 0.03).
English
0196-8092
10.1002/lsm.23669 [doi]
*Lichen Sclerosus et Atrophicus
*Vulvar Lichen Sclerosus
Atrophy/co [Complications]
Biopsy
Carbon Dioxide
Female
Humans
Inflammation
Lichen Sclerosus et Atrophicus/co [Complications]
Lichen Sclerosus et Atrophicus/pa [Pathology]
Middle Aged
Pilot Projects
Postmenopause
Prospective Studies
Sclerosis/co [Complications]
Vulvar Lichen Sclerosus/co [Complications]
Vulvar Lichen Sclerosus/pa [Pathology]
Vulvar Lichen Sclerosus/th [Therapy]--Automated
Dermatology
MedStar Health Research Institute
MedStar Washington Hospital Center
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Infectious Diseases Fellowship
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Obstetrics and Gynecology
Case Reports