TY  - BOOK
AU  - Cardis, Michael A
AU  - Dieter, Alexis A
AU  - Gonzales, Melissa K
AU  - Iglesia, Cheryl B
AU  - Lee, Jennifer 
AU  - Sokol, Andrew I
AU  - Tefera, Eshetu
TI  - A prospective pilot study to assess for histologic changes on vulvar biopsies in postmenopausal women with lichen sclerosus treated with fractionated CO2 laser therapy
SN  - 0196-8092
PY  - 2023///
KW  - *Lichen Sclerosus et Atrophicus
KW  - *Vulvar Lichen Sclerosus
KW  - Atrophy/co [Complications]
KW  - Biopsy
KW  - Carbon Dioxide
KW  - Female
KW  - Humans
KW  - Inflammation
KW  - Lichen Sclerosus et Atrophicus/co [Complications]
KW  - Lichen Sclerosus et Atrophicus/pa [Pathology]
KW  - Middle Aged
KW  - Pilot Projects
KW  - Postmenopause
KW  - Prospective Studies
KW  - Sclerosis/co [Complications]
KW  - Vulvar Lichen Sclerosus/co [Complications]
KW  - Vulvar Lichen Sclerosus/pa [Pathology]
KW  - Vulvar Lichen Sclerosus/th [Therapy]
KW  - Automated
KW  - Dermatology
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
KW  - Infectious Diseases Fellowship
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology
KW  - Case Reports
N2  - 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)
UR  - https://dx.doi.org/10.1002/lsm.23669
ER  -